THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

LOS  ANGELES 

GIFT  OF 


i-  EDIT 


ADEI/ 
j 


X 

* 


•IF 


V. 


MEDICAL  INQUIRIES 


AND 


UPON 


THE   DISEASES   OF  THE  MIND. 


BY  BENJAMIN  RUSH,  M.  D. 

PROFESSOR  OF  THE  INSTITUTES  AND  PRACTICE  OF  MEDICINE,  AND  OF  CLINICAL 
PRACTICE,  IN  THE  UNIVERSITY  OF  PENNSYLVANIA. 


FIFTH  EDITION. 


PHILADELPHIA: 

PUBLISHED    BY    GRIGG    AND    ELLIOT 

NO.  9  3TOHTH  FOURTH  STREET. 

1835. 


Eastern  District  of  Pennsylvania,  to  wit : 

Be  it  remembered,  that  on  the  first  day  of  December,  A.  D.,  1825,  in  the 
fiftieth  year  of  the  Independence  of  the  United  States  of  America,  William 
Rush,  of  the  said  district,  has  deposited  in  this  office ^he  title  of  a  Book,  the 
right  whereof  he  claims  as  proprietor  in  the  words  following,  to  wit : — 

"Medical  Inquiries  and  Observations  upon  the  Diseases  of  the  Mind. 
By  Benjamin  Rush,  M.  D.,  Professor  of  the  Institutes  and  Practice  of 
Medicine,  and  of  Clinical  Practice,  in  the  University  of  Pennsylvania." 

In  conformity  to  the  Act  of  the  Congress  of  the  United  States,  entitled 
"  An  act  for  the  encouragement  of  learning,  by  securing  the  copies  of  maps, 
charts  and  books,  to  the  authors  and  proprietors  of  such  copies,  during  the 
times  therein  mentioned :"  and  also  to  an  act  entitled,  "  An  act  supple- 
mentary to  an  act,  entitled,  An  act  for  the  encouragement  of  learning,  by 
securing  the  copies  of  maps,  charts  and  books,  to  the  authors  and  proprietors 
of  such°copies,  during  the  times  therein  mentioned';  and  extending  the  bene- 
fits thereof  to  the  arts  of  designing,  engraving,  and  etching  historical  and 

0therprintS''  D.  CALDWELL. 

Clerk  of  the  Eastern  District  of  Pennsylvania. 


Printed  by  J.  Crissy  &  G.  Goodman,  4  Minor  St. 


College 
Library 


CONTENTS, 


CHAPTER  I.  PAGE 

Of  the  Faculties  and  Operations  of  the  Mind,  and  on  the  Proximate 
Cause  of  Intellectual  Derangement 7 

CHAPTER  II. 
Of  its  Remote,  Exciting  and  Predisposing  Causes 

CHAPTER  III. 

Of  Partial   Intellectual  Derangement,  and  particularly  of  Hypochon- 
driasis,  or  Tristimania      -----,-- 72 

Of  the  Remedies  for  Hypochondriasis  or  Tristimania 96 

CHAPTER  IV. 

Of  Amenomania,   or  Partial   Intellectual   Derangement  accompanied 
with  Pleasure,  or  not  accompanied  with  Distress 133 

CHAPTER  V. 

Of  General  Intellectual  Derangement 139 

Of  the  symptoms  of  Mania 140 

Of  the  different  forms  of  Mania    -  -  160 

Of  the  Influence  of  the  Moon  on  Mania  -  1G8 

CHAPTER  VI. 
Of  the  Remedies  for  Mania ...  174 

CHAPTER  VII. 
Of  Manicula    -  -  212 

CHAPTER  VIII. 

Of  Manalgia    -  -  214 

Of  the  Remedies  for  Manalgia      -  -    -    -    -    -  219 

Of  the  Means  of  Improving  the  Condition  of  Mad  People  -  -  239 

Signs  of  a  Favourable  and  Unfavourable  Issue  of  all  the  Forms  of  In- 
tellectual Derangement    -    -     •                                    .._...  246 
TJsual  Modes  of  Death  from  them -  254 


IV  CONTENTS. 


CHAPTER  IX.  PAGE 

Of  Demence,  or  Dissociation    .-------•--.--  257 

CHAPTER  X. 
Of  Derangement  in  the  Will 261 

CHAPTER  XI. 
Of  Derangement  in  the  Principle  of  Faith,  or  the  Believing  Faculty    -  269 

CHAPTER  XII. 

Of  Derangement  of  the  Memory 274 

Of  the  Remedies  for  it 281 

CHAPTER  XIII. 
Of  Fatuity 289 

CHAPTER  XIV. 
Of  Dreaming,  Incubus,  or  Night  Mare,  and  Somnambulism       -    -    -  298 

CHAPTER  XV. 
Of  Illusions 304 

CHAPTER  XVI. 
Of  Reverie,  or  Absence  of  Mind 308 

CHAPTER  XVII. 

Of  Derangement  of  the  Passions 

Of  Love       -  312 

Of  Grief  316 

Of  Fear  -  -    - 322 

Of  Anger    -    - 331 

Of  the  morbid  Effects  of  Envy,  Malice  and  Hatred       .....     -  338 
Of  the  Torpor  of  the  Passions      -    •  ....  343 

CHAPTER  XVIII. 
Of  the  morbid  State  of  the  Sexual  Appetite  ...  345 

CHAPTER  XIX. 

Of  the  Derangement  in  the  moral  Faculties    -  -    -    -  355 


PREFACE. 


AGREEABLY  to  a  promise  made  to  the  public  some  years 
ago,  and  in  compliance  with  the  solicitations  of  the  author's 
pupils,  he  now  offers  to  them  a  volume  of  Medical  Inquiries 
and  Observations,  upon  the  Diseases  of  the  Mind. 

The  views  which  he  has  taken  of  the  proximate  cause,  forms, 
and  symptoms  of  those  diseases,  have  obliged  him  to  employ  a 
new  nomenclature  to  designate  some  of  them.  This  becomes 
no  less  necessary  where  new  opinions  are  proposed,  or  new 
symptoms  described  in  the  history  of  diseases,  than  an  increase 
in  the  number  of  words,  and  new  combinations  of  them,  become 
necessary  to  accompany  the  increase  of  the  wants  and  objects 
of  civilized  society. 

Some  of  the  facts  contained  in  the  following  pages  are  of  an 
old  date,  and  will  be  familiar  to  the  medical  reader,  but  the 
publication  of  them,  it  is  hoped,  will  be  excused,  when  it  is 
perceived,  that  they  are  placed  under  the  direction  of  new 
principles,  and  that  new  inferences  of  a  practical  nature  are 
deduced  from  them.  An  apology  may  seem  necessary  like- 
wise for  the  large  number  of  recent  facts  that  have  been  added 
to  them.  Upon  subjects  so  interesting  as  the  present,  more 
than  common  testimony  is  necessary  to  produce  conviction. 
Besides,  facts,  or  precedents,  have  the  saine  effects  in  reason- 
ing in  medicine,  that  examples  have  in  morals.  They  compel 
the  reader  to  admit  the  practice  they  are  intended  to  establish, 
provided  they  are  applied  in  a  proper  manner. 


V  PREFACE. 

4 

The  author  has  omitted  referring  to  the  books  from  which 
he  has  obtained  some  of  his  facts.  His  reason  for  doing  so 
was,  when  he  began  to  collect  them,  he  did  not  expect  to  pub- 
lish them,  and  of  course  did  not  mark  the  volumes  and  pages 
from  which  they  were  extracted.  Since  he  formed  that  design 
he  has  faithfully  preserved  references  to  them  both.  He  has 
suppressed  them,  only  because  their  partial  publication  would 
have  destroyed  the  uniformity  of  the  work.  He  commits  his 
imperfect  labours,  now  before  the  reader,  to  his  fellow  citizens, 
with  a  hope  that  they  may  serve  as  a  supplement  to  materials 
already  collected,  from  which  a  system  of  principles  may  be 
formed  that  shall  lead  to  general  success  in  the  treatment  of  the 
diseases  of  the  mind.  Experience  -has  exhausted  herself  in 
abortive  efforts  for  that  purpose,  and  should  the  following 
attempt  to  co-operate  with  her  by  principles  be  alike  unsuccess- 
ful, it  must  be  ascribed  to  their  being  erroneous,  for  the  author 
believes  those  diseases  can  be  brought  under  the  dominion  of 
medicine,  only  by  just  theories  of  theiv  seats  and  proximate 
cause. 

BENJAMIN  RUSH. 

PHILADELPHIA,  OCTOBER,  1812. 


1 

*•    '         '     % 


MEDICAL 
INQUIRIES  AND  OBSERVATIONS 


Olf 

I 

THE   DISEASES    OF   THE   MIND. 


CHAPTER  I. 

Of  the  Faculties  and  Operations  of  the  Mind,  and  on 
the  Proximate  Cause  and  Seat  of  Intellectual  De- 
rangement. 

IN  entering  upon  the  subject  of  the  following 
Inquiries  and  Observations,  I  feel  as  if  I  were 
about  to  tread  upon  consecrated  ground.  I  am 
aware  of  its  difficulty  and  importance,  and  I  thus 
humbly  implore  that  BEING,  whose  government 
extends  to  the  thoughts  of  all  his  creatures,  so  to 
direct  mine,  in  this  arduous  undertaking,  that  no- 
thing hurtful  to  my  fellow  citizens  may  fall  from 
my  pen,  and  that  this  work  may  be  the  means  of 
lessening  a  portion  of  some  of  the  greatest  evils 
of  human  life. 


ON  THE  DISEASES 


Before  I  proceed  to  consider  the  diseases  of  the 
mind,  I  shall  briefly  mention  its  different  faculties 
and  operations. 

Its  faculties  are,  Understanding,  Memory,  Im- 
agination, Passions,  the  principle  of  Faith,  Will, 
the  Moral  faculty,  Conscience,  and  the  sense  of 
Deity. 

Its  principal  operations,  after  sensation,  are 
Perception,  Association,  Judgment,  Reasoning 
and  Volition.  All  its  subordinate  operations, 
which  are  known  by  the  names  of  Attention,  Re- 
flection, Contemplation,  Wit,  Consciousness,  and 
the  like,  are  nothing  but  modifications  of  the  five 
principal  operations  that  have  been  mentioned. 

The  faculties  of  the  mind  have  been  called,  very 
happily,  internal  senses.  They  resemble  the  exter- 
nal senses  in  being  innate,  and  depending  wholly 
upon  bodily  impressions  to  produce  their  specific 
operations.  These  impressions  are  made  through 
the  medium  of  the  external  senses.  As  well  might 
we  attempt  to  excite  thought  in  a  piece  of  marble 
by  striking  it  with  our  hand,  as  expect  to  produce 
a  single  operation  of  the  mind  in  a  person  de- 
prived of  the  external  senses  of  touch,  seeing, 
hearing,  taste  and  smell. 


OF  THE  MIND.  9 

All  the  operations  in  the  mind  are  the  effects  of 
motions  previously  excited  in  the  brain,  and  every 
idea  and  thought  appears  to  depend  upon  a  mo- 
tion peculiar  to  itself.  In  a  sound  state  of  the 
mind,  these  motions  are  regular,  and  succeed  im- 
pressions upon  the  brain  with  the  same  certainty 
and  uniformity  that  perceptions  succeed  impres- 
sions upon  the  senses  in  their  sound  state. 

In  inquiring  into  the  causes  of  the  diseases  of 
the  mind,  and  the  remedies  that  are  proper  to  re- 
lieve them,  I  shall  employ  the  term  derangement, 
to  signify  the  diseases  of  all  the  faculties  of  the 
mind. 

As  the  understanding  occupies  the  highest  rank 
of  those  faculties,  and  as  it  is  most  frequently  the 
seat  of  derangement,  I  shall  begin  by  considering 
the  causes,  and  all  the  states  arid  forms  of  its  dis- 
eases. 

By  derangement  in  the  understanding,  I  mean 
every  departure  of  the  mind  in  its  perceptions, 
judgments,  and  reasonings,  from  its  natural  and 
habitual  order;  accompanied  with  corresponding 
actions.  It  differs  from  delirium,  whether  acute, 
or  chronic,  in  being  accompanied  with  a  departure 
from  habitual  order,  in  incoherent  conduct,  as  well 

2 


10  ON  THE  DISEASES 

as  conversation.  The  latter,  however,  is  not  ne- 
cessary to  constitute  intellectual  madness,  for  we 
sometimes  meet  with  the  most  incongruous  ac- 
tions without  incoherent  speech,  and  we  now  and 
then  meet  with  incoherent  speech  in  mad  people, 
in  whom  the  disease  does  not  destroy  their  habits 
of  regular  conduct.  This  is  evinced  by  the  cor- 
rectness with  which  they  sometimes  perform  cer- 
tain mechanical  and  menial  pieces  of  business. 
Madness  is  to  delirium  what  walking  in  sleep  is  to 
dreaming.  It  is  delirium,  heightened  and  pro- 
tracted by  a  more  active  and  permanent  stimulus 
upon  the  brain.* 

Let  it  not  be  supposed  that  intellectual  derange- 
ment always  affects  the  understanding  exclusively 
in  the  manner  that  has  been  mentioned.  Far  from 
it.  Two  or  more  of  the  faculties  are  generally 
brought  into  sympathy  with  it,  and  there  are  cases 
in  which  all  the  faculties  are  sometimes  deranged 
in  succession  and  rotation ;  and  now  and  then  they 
are  all  affected  at  the  same  time.  This  occurs 
most  frequently  in  the  beginning  of  a  paroxysm  of 

*  The  reader  will  find  several  other  distinguished  marks  be- 
tween madness  and  delirium,  applicable  to  legal  purposes,  in  the 
author's  Introductory  Lecture  upon  MedicalJurisprudence,  pub- 
lished in  a  volume  of  Lectures,  by  Bradford  and  Inskeep,  in  the 
year  1810. 


OF  THE  MIND.  1  1 

intellectual  madness,  but  it  rarely  continues  to 
affect  the  other  faculties  of  the  mind  after  two  or 
three  weeks,  or  after  the  liberal  use  of  depleting 
remedies.  Thus  fever,  in  its  first  attack,  affects 
the  bowels  and  nervous  system,  and  in  a  few  days 
settles  down  into  a  disease  chiefly  of  the  blood- 
vessels. 

Derangement  in  the  understanding,  has  been 
divided  into  partial  and  general.  The  causes  of 
both  are  the  same.  I  should  proceed  immediately 
to  enumerate  them,  but  as  the  seat  or  proximate 
cause  of  a  disease  is  generally  the  first  object  of 
a  physician's  inquiry  on  entering  a  sick  room,  it 
shall  be  the  first  -subject  of  our  consideration  in 
the  present  inquiry. 

1.  The  most  ancient  opinion,  of  the  proximate 
cause  of  intellectual  derangement,  or  what  has 
been  called  madness,  is,  that  it  is  derived  from  a 
morbid  state  of  the  liver,  and  that  it  discovers 
itself  in  a  vitiated  state  of  the  bile.  Hippocrates 
laid  the  foundation  of  this  error  by  his  encomium 
upon  Democritus,  whom  he  found  employed  in 
examining  the  liver  of  a  dumb  animal  in  order  to 
discover  the  cause  of  madness. 


12  ON  THE  DISEASES 

2.  Madness  has  been  said  to  be  the  effect  of 
a  disease  in  the  spleen.     This  viscus  is  supposed 
to  be  affected  in  a  peculiar  manner  in  that  grade 
of  madness  which  has  been  called  hypochondria- 
sis.     For  many  years  it  was  known  in  England 
by  no  other  name  than  the  spleen,  and  even  to 
this  day,  persons  who  are  affected  with  it  are  said 
to  be  spleeny,  in  some  parts  of  the  New  England 
states. 

3.  A  late  French  writer,  Dr.  Prost,  in  an  inge- 
nious work  entitled  "  Medecine  Eclairee  par  Ob- 
servation  et  POverture   des  Corps,"  has  taken 
pains  to  prove  that  madness  is  the  effect  of  a  dis- 
ease in  the  intestines,  and  particularly  of  their 
peritoneal   coat.     The   marks    of   inflammation 
which  appear  in  the  bowels  in  persons  who  have 
died   of  madness,  have   no  doubt  favoured  this 
opinion;  but  these  morbid  appearances,  as  well 
as  all  those  which  are  often  met  with  in  the  liver, 
spleen,  and  occasionally  in  the  stomach,  in  per- 
sons who  have  died  of  madness,  are  the  effects 
and  not  the  causes  of  the   disease.     They  are 
induced  either,   1st,  by  the  violent  or  protracted 
exercises  of  the  mind  attracting  or  absorbing  the 
excitement  of  those  viscera,  and  thereby  leaving 
them  in  that  debilitated  state  which  naturally  dis- 
poses   them    to    inflammation  and  obstruction. 


OF  THE  MIND.  13 


Thus  diseases  in  the  stomach  induce  torpor  and 
costiveness  in  the  alimentary  canal.  Thus  too 
local  inflammation  often  induces  coldness  and  in- 
sensibility in  contiguous  parts  of  the  body.  Or, 
2d,  they  are  induced  by  the  reaction  of  the  mind 
from  the  impressions  which  produce  madness,  be- 
ing of  such  a  nature  as  to  throw  its  morbid  excite- 
ment upon  those  viscera  with  so  much  force  as  to 
produce  inflammation  and  obstructions  in  them. 
That  they  are  induced  by  one,  or  by  both  these 
causes,  I  infer  from  the  increased  secretion  and 
even  discharge  of  bile  which  succeed  a  paroxysm 
of  anger;  from  the  pain  in  the  left  side,  or  spleen, 
which  succeeds  a  paroxysm  of  malice  or  revenge; 
and  from  the  pain,  and  other  signs  of  disease  in 
the  bowels  and  stomach  which  follow  the  chronic 
operations  of  fear  and  grief.  That  the  disease 
and  disorders  of  all  the  viscera  that  have  been 
mentioned,  are  the  effects,  and  not  the  causes  of 
madness,  I  infer  further  from  their  existing  for 
weeks,  months  and  years  in  countries  subject  to 
intermitting  fevers,  without  producing  madness, 
or  even  the  least  alienation  of  the  mind. 

4.  Madness,  it  has  been  said,  is  the  effect  of  a 
disease  in  the  nerves.  Of  this,  dissections  afford 
us  no  proofs;  on  the  contrary,  they  generally 
exhibit  the  nerves  after  death  from  madness  in  a 


14  ON  THE  DISEASES 

sound  state.  I  object  further,  to  this  opinion, 
that  hysteria,  which  is  universally  admitted  to  be 
seated  chiefly  in  the  nerves  and  muscles,  often 
continues  for  years,  and  sometimes  during  a  long 
life,  without  inducing  madness,  or  if  the  mind  be 
alienated  for  a  few  minutes  in  one  of  its  paroxysms, 
it  is  only  from  its  bringing  the  vascular  system  into 
sympathy,  in  which  1  shall  say  presently  the  cause 
of  madness  is  primarily  seated.  The  reaction  of 
the  mind  from  the  impressions  which  produce 
hysteria,  discovers  itself  in  the  bowels,  in  the  kid- 
neys, and  in  most  of  the  muscular  parts  of  the 
body. 

5,  and  lastly.  Madness  has  been  placed  exclu- 
sively in  the  mind.  I  object  to  this  opinion,  1st, 
because  the  mind  is  incapable  of  any  operations 
independently  of  impressions  communicated  to  it 
through  the  medium  of  the  body.  2d,  Because 
there  are  but  two  instances  upon  record  of  the 
brain  being  found  free  from  morbid  appearances 
in  persons  who  have  died  of  madness.  One  of 
these  instances  is  related  by  Dr.  Stark,  the  other 
by  Dr.  De  Haen.  They  probably  arose  from  the 
brain  being  diseased  beyond  that  grade  in  which 
inflammation  and  its  usual  consequences  take 
place.  Did  cases  of  madness  reside  exclusively 
in  the  mind,  a  sound  state  of  the  brain  ought  to 
occur  after  nearly  every  death  from  that  disease. 


OF  THE  MIND.  15 

I  object  to  it,  3,  because  there  are  no  instances 
of  primary  affections  of  the  mind,  such  as  grief, 
love,  anger,  or  despair,  producing  madness  until 
they  had  induced  some  obvious  changes  in  the 
body,  such  as  wakefulness,  a  full  or  frequent 
pulse,  costiveness,  a  dry  skin,  and  other  symptoms 
of  bodily  indisposition. 

I  know  it  has  been  said  in  favour  of  madness 
being  an  ideal  disease,  or  being  seated  primarily 
in  the  mind,  that  sudden  impressions  from  fear, 
terror,  and  even  ridicule,  have  sometimes  cured 
it.  This  is  true,  but  they  produce  their  effects 
only  by  the  healthy  actions  they  induce  in  the 
brain.  We  see  several  other  diseases,  particu- 
larly hiccup,  headach,  and  even  fits  of  epilepsy, 
which  are  evidenly  affections  of  the  body,  cured 
in  the  same  way  by  impressions  of  fear  and  terror 
upon  the  mind. 

Having  rejected  the  abdominal  viscera,  the 
nerves,  and  the  mind,  as  the  primary  seats  of  mad- 
ness, I  shall  now  deliver  an  opinion,  which  I  have 
long  believed  and  taught  in  my  lectures,  and  that 
is,  that  the  cause  of  madness  is  seated  primarily  in 
the  blood-vessels  of  the  brain,  and  that  it  depends 
upon  the  same  kind  of  morbid  and  irregular 
actions  that  constitutes  other  arterial  diseases. 


16  ON  THE  DISEASES 

There  is  nothing  specific  in  these  actions.  They 
are  a  part  of  the  unity  of  disease,  particularly  of 
fever;  of  which  madness  is  a  chronic  form,  affect- 
ing that  part  of  the  brain  which  is  the  seat  of  the 
mind. 

My  reasons  for  believing  the  cause  of  madness 
to  be  seated  in  the  blood-vessels  of  the  brain  are 
drawn, 

I.  From  its  remote  and  exciting  causes,  many 
of  which  are  the  same  with  those  which  induce 
fever  and  certain  diseases  of  the  brain,  particu- 
larly phrenitis,  apoplexy,  palsy  and  epilepsy,  all  of 
which   are  admitted   to    have  their    seats  in  a 
greater  or  less  degree  to  the  blood-vessels.     Of 
thirty-six  dissections  of  the  brains  of  persons  who 
had  died  of  madness,  Mr.  Pinel  says  he  could  per- 
ceive no  difference  between  the  morbid  appear- 
ances in  them,  and  in  the  brains  of  persons  who 
had  died  of  apoplexy  and  epilepsy.  The  sameness 
of  these  appearances,  however,  do  not  prove  that 
all  those  diseases  occupy  the  same  parts  of  the 
brain:  I  believe  they  do  not,  especially  in  their 
first  stage :  they  become  diffused  over  the  whole 
brain,  probably  in  their  last  stages,  or  in  the  pa- 
roxysm  of  death.     Dr.  Johnson,   of  Exeter,  in 
speaking  of  the  diseases  of  the  abdominal  viscera, 


OF  THE  MIND.  17 

mentions  their  sympathy  with  each  other,  by  what 
he  very  happily  calls  "  an  intercommunion  of  sen- 
sation." It  would  seem  as  if  a  similar  intercom- 
munion took  place  between  all  the  diseases  of  the 
brain.  It  is  remarkable  they  all  discover,  in  every 
part  of  the  brain,  marks  of  a  morbid  state  of  the 
blood-vessels. 

II.  From  the  ages  and  constitutions  of  persons 
who  are  most  subject  to  madness.     The  former 
are  in  those  years  in  which  acute  and  inflamma- 
tory arterial  diseases  usually  affect  the  body,  and 
the  latter,  in  persons  who  labour  under  the  arte- 
rial predisposition. 

III.  I  infer  that  madness  is  seated  in  the  blood- 
vessels, 

1.  From  its  symptoms.  These  are  a  sense  of 
fulness,  and  sometimes  pain  in  the  head ;  wake- 
fulness,  and  a  redness  of  the  eyes,  such  as  precede 
fever,  a  whitish  tongue,  a  dry  or  moist  skin,  high 
coloured  urine,  a  frequent,  full  or  tense  pulse,  or  a 
pulse  morbidly  slow  or  natural  as  to  frequency. 
These  states  of  the  pulse  occur  uniformly  in  re- 
cent madness,  and  one  of  them,  that  is  frequency, 
is  seldom  absent  in  its  chronic  state. 


18  ON  THE  DISEASES 

I  have  taken  notice  of  the  presence  of  this 
symptom  in  my  Introductory  Lecture  upon  the 
study  »of  Medical  Jurisprudence,  in  which  I  have 
mentioned,  that  seven-eighths  of  all  the  deranged 
patients  in  the  Pennsylvania  Hospital  in  the  year 
1811,  had  frequent  pulse,*  and  that  a  pardon  was 
granted  to  a  criminal  by  the  president  of  the 
United  States,  in  the  year  1794,  who  was  sus- 
pected of  counterfeiting  madness,  in  consequence 
of  its  having  been  declared,  by  three  physicians, 
that  that  symptom  constituted  an  unequivocal 
mark  of  intellectual  derangement. 

The  connection  of  this  disease  with  the  state 
of  the  pulse,  has  been  further  demonstrated  by  a 
most  satisfactory  experiment,  made  by  Dr.  Coxe, 
and  related  by  him  in  his  Practical  Observations 
upon  Insanity.  He  gave  digitalis  to  a  patient 
who  was  in  a  furious  state  of  madness,  with  a 
pulse  that  beat  90  strokes  in  a  minute.  As  soon 

*  This  fact  was  ascertained,  at  my  request,  with  great  ac- 
curacy, by  Dr.  Frederick  Vandyke.  It  is  probable  the  pulsa- 
tions of  the  arteries  in  the  brain  were  preternaturally  frequent 
in  the  brain  in  the  few  cases  in  which  they  were  natural  at  the 
wrists.  Dr.  Cox,  of  Bristol,  informs  us  that  he  had  found  the 
carotid  artery  to  be  full  and  tense,  when  the  radial  artery  was 
weak  and  soft. 


OF  THE  MIND.  19 

as  the  medicine  reduced  his  pulse  to  70,  he  be- 
came rational.  Upon  continuing  it,  his  pulse  fell 
to  50,  at  which  time  he  became  melancholy.  An 
additional  quantity  of  the  medicine  reduced  it  to 
40  strokes  in  a  minute,  which  nearly  suspended 
his  life.  He  was  finally  cured  by  lessening  the 
doses  of  the  medicine  so  as  to  elevate  his  pulse 
to  70  strokes  in  a  minute,  which  was  probably 
its  natural  state.  In  short,  there  is  not  a  single 
symptom  that  takes  place  in  an  ordinary  fever, 
except  a,  hot  skin,  that  does  not  occur  in  the  acute 
state  of  madness. 

IV.  From  its  alternating  with  several  diseases 
which  are  evidently  seated  in  the  blood-vessels. 
These  are  consumption,  rheumatism,  intermitting 
and  puerperal  fever,  and  dropsy,  many  instances 
of  which  are  to  be  met  with  in  the  records  of  me- 
dicine. 

V.  From  its  blending  its  symptoms  with  several 
of  the  forms  of  fever.     It  is  sometimes  attended 
with   regular   intermissions,   and   remissions.      I 
have   once  seen  it  appear  with  profuse  sweats, 
such  as  occur  in  certain  fevers,  in  a  madman  in 
the  Pennsylvania  Hospital.     These  sweats,  when 
discharged  from  his  skin,  formed  a  vapour  resem- 
bling a  thick  fog,  that  filled  the  cell  in  which  he 


20  ON  THE  DISEASES 

was   confined,  to  such   a  degree  as    to  render 
his  body  scarcely  visible. 

Again,  this  disease  sometimes  appears  in  a 
typhus  form,  in  which  it  is  attended  with  cold- 
ness, a  feeble  pulse,  muttering  delirium,  and  in- 
voluntary discharge  of  faeces  and  urine.  But  it 
now  and  then  pervades  the  whole  country  in  the 
form  of  an  epidemic.  It  prevailed  in  this  way  in 
England  in  the  years  1355  and  in  1373,  and  in 
France  and  Italy  in  the  year  1374,  and  Dr.  Win- 
tringham  mentions  its  frequent  occurrence  in 
England  in  the  year  1719. 

A  striking  instance  of  the  union  of  madness 
with  common  fever  is  mentioned  by  Lucian.  He 
tells  us  that  a  violent  fever  once  broke  out  at 
Abdera,  which  terminated  by  hemorrhages,  or 
sweats,  on  the  seventh  day.  During  the  conti- 
nuance of  this  fever  the  patients,  affected  with  it, 
repeated  passages  from  the  tragedy  of  Andro- 
meda with  great  vehemence,  both  in  their  sick- 
rooms and  in  the  public  streets.  This  mixture  of 
fever  and  madness  continued  until  the  coming  on 
of  cold  weather.  Lucian  ingeniously  and  very 
properly  ascribes  it  to  the  persons  affected,  having 
heard  the  famous  player  Archilaus  act  a  part  in 
the  above  tragedy  in  the  middle  of  summer  in  so 


OF  THE  MIND.  21 

impressive  a  manner,  that  it  excited  in  them  the 
seeds  of  a  dormant  fever  which  blended  itself 
with  derangement,  and  thus  produced,  very  natu- 
rally, a  repetition  of  the  ideas  and  sounds  that 
excited  their  disease. 

VI.  From  the  appearances  of  the  blood  which 
is  drawn  in  this  disease  being  the  same  as  that 
which  is   drawn   in   certain    fevers.     They   are, 
inflammatory  buff,  yellow,  serum  and  'lotura  car- 
nium. 

VII.  From  the  appearances  of  the  brain  after 
death  from  madness.     These  are  nearly  the  same 
as  after  death  from  phrenitis,  apoplexy,  and  other 
diseases  which  are  admitted  to  be  primary  affec- 
tions of  the  blood-vessels  of  the  brain.     I  shall 
briefly  enumerate  them;  they  are,  1,  the  absence 
of  every  sign  of  disease.     I  have  ascribed  this  to 
that  grade  of  suffocated  excitement  which  pre- 
vents the  effusion  of  red  blood  into  the  serous 
vessels.     We  observe  the. same  absence  of  the 
marks  of  inflammation  after  several  other  violent 
diseases.     Dr.  Stevens,  in  his  ingenious  inaugural 
dissertation,   published  in   1811,  has  called  this 
apparently  healthy  appearance,  the   "airnatous" 
state  of  inflammation.    Perhaps  it  would  be  more 
proper  to  call  it  the  "  aimatous"  state  of  disease. 


22  ON  THE  DISEASES 

«*• 

It  is  possible  it  may  arise  in  recent  cases  of  mad- 
ness which  terminate  fatally,  from  the  same  re- 
trospection of  the  blood  from  the  brain,  which 
takes  place  from  the  face  and  external  surface 
of  the  body  just  before  death*.  But, 

2.  We  much  oftener  discover  in  the  brain,  after 
death  from  madness,  inflammation,  effusions  of 
water  in  its  ventricles,  extravasation  and  intrava- 
tion  of  blood,  and  even  pus.  After  chronic  mad- 
ness, we  discover  some  peculiar  appearances 
which  have  never  been  met  with  in  any  other  dis- 
ease of  the  brain,  and  these  are  a  preternatural 
hardness,  and  dryness  in  all  its  parts.  Lieutaud 
mentions  it  often  with  the  epithets  of  "  durum," 
"  praedurum,"  "siccum,"  and  "  exsuccum."  Mor- 
gagni  takes  notice  of  this  hardness  likewise,  and 
says  he  had  observed  it  in  the  cerebrum  in  per- 
sons in  whom  the  cerebellum  retained  its  natural 
softness.  Dr.  Baillie  and  Mr.  John  Hunter  have 
remarked,  that  the  brain  in  this  state  discovered 
marks  of  elasticity  when  pressed  by  the  fingers. 
Mr.  Mickell  ,says  a  cube  of  six  lines  of  the  brain 
of  a  maniac,  thus  indurated,  weighed  seven 
drachms,  whereas  a  cube  of  the  same  dimension 
of  a  sound  brain  weighed  but  one  drachm,  and 
between  four  and  six  grains.  I  have  ascribed  this 
hardness,  dryness,  elasticity  and  relative  weight  of 


OF  THE  MIND.  23 

the  brain  to  a  tendency  to  schirrus,  such  as  suc- 
ceeds morbid  action  or  inflammation  in  glandular 
parts  of  the  body,  and  particularly  that  early  grade 
of  it  which  occurs  in  the  liver,  and  which  is 
known  by  the  name  of  hepitalgia.  The  brain  in 
this  case  loses  its  mobility  so  as  to  become  inca- 
pable of  emitting  those  motions  from  impressions 
which  produce  the  operations  of  the  mind. 

3.  We  sometimes  discover  preternatural  soft- 
ness in  the  brain,  in  persons  who  die  of  madness, 
similar  to  that  which  we  find  in  other  viscera  from 
common  and  febrile  diseases.     This  has  been 
observed  to  occur  most  frequently  in  the  kidneys 
and  spleen.     The  brain  in  this  case  partakes  of 
its  texture  and  imbecility  in  infancy,  and  hence 
its  inability  to  receive  and  modify  the  impressions 
which  excite  thought  in  the  mind. 

4.  and  lastly.     We  sometimes  discover  a  pre- 
ternatural enlargement  of  the  bones  of  the  head 
from  madness,  and    sometimes   a    preternatural 
reduction  of  their  thickness.     Of  216   maniacs 
whose  heads   were   examined   after    death,   Dr. 
Creighton  says,  in   160  the   skull  was  enlarged, 
and  in  38  it  was  reduced  in  its  thickness.     Now 
the  same  thing  succeeds  rheumatism,  and  many 


24  ON  THE  DISEASES 

other  febrile  diseases  which  exert  their  action  in 
the  neighbourhood  of  bones. 

I  might  add  further,  under  this  head,  that  the 
morbid  appearances  in  the  spleen,  liver,  and  sto- 
mach, which  are  seen  after  death  from  madness, 
place  it  still  more  upon  a  footing  with  fevers  from 
all  its  cases,  and  particularly  from  koino-mias- 
matic  exhalations,  and  in  a  more  especial  manner 
when  they  affect  the  brain,  and  thereby  induce 
primary,  or  idiopathic  phrenitis.  In  short,  mad- 
ness is  to  phrenitis,  what  pulmonary  consumption 
is  to  pneumony,  that  is,  a  chronic  state  of  an 
acute  disease.  It  resembles  pulmonary  consump- 
tion further,  in  the  excitement  of  the  muscles,  and 
in  the  appetite  continuing  in  a  natural,  or  in  a 
preternatural  state. 

VIII.  I  infer  madness  to  be  primarily  seated  in 
the  blood-vessels,  from  the  remedies  which  most 
speedily  and  certainly  cure  it,  being  exactly  the 
same  as  those  which  cure  fever  or  disease  in  the 
blood-vessels  from  other  causes,  and  in  other 
parts  of  the  body.  They  will  be  noticed  in  their 
proper  place. 

I  have  thus  mentioned  the  facts  and  arguments 
which  prove  what  is  commonly  called  madness  to 


OF  THE  MIND.  25 

be  a  disease  of  the  blood-vessels  of  the  brain.  All 
the  other  and  inferior  forms  of  derangement,  whe- 
ther of  the  memory,  the  will,  the  principle  of  faith 
the  passions,  and  the  moral  faculties,  I  believe  to 
be  connected  more  or  less  with  morbid  action  in 
the  blood-vessels  of  the  brain  or  heart,  according 
to  the  seats  of  those  faculties  of  the  mind. 

In  placing  the  primary  seat  of  madness  in  the 
blood-vessels,  I  would  by  no  means  confine  the 
predisposition  to  it  exclusively  to  them.     It  ex- 
tends to  the  nerves,  and  to  that  part  of  the  brain, 
which  is  the  seat  of  the  mind,  both  of  which, 
when  preternaturally  irritable,  communicate  more 
promptly  deranged  action  to  the  blood-vessels  of 
the  brain.    I  have  called  the  union  of  this  diffused 
morbid  irritability,  the   phrenitic  predisposition. 
It  is  from  the  constant  presence  of  this  predispo- 
sition, that  some  people  are  seldom  affected  with 
the  slightest  fever,  without  becoming  delirious ; 
and  it  is  from  its  absence,  that  many  people  are 
affected   with  fevers  and  other  diseases  of  the 
brain  without  being  affected  with  derangement. 
I  am  aware  that  it  may  be  objected  to  the  proxi- 
mate cause  or  seat  of  madness,  which  has  been 
delivered,  that  dissections  have  sometimes  dis- 
covered marks  of  arterial  diseases  in  the  brain, 

4 


26  ON  THE  DISEASES 

similar  to  those  that  have  been  mentioned,  which 
were  not  preceded  by  the  least  alienation  of  mind. 
In  these  cases,  I  would  suppose  the  diseases  may 
have  existed  in  parts  of  the  brain  which  are  not 
occupied  by  the  mind,  or  that  the  mind  may  have 
been  translated  to  another,  and  a  healthy  part  of 
the  brain.    The  senses  of  taste  and  hearing,  we 
know,  when  impaired  by  disease,  are  often  trans- 
lated to  contiguous,  and  sometimes  to  remote 
parts  of  the  body.     But  did  we  admit  the  objec- 
tion that  I  have  met,  to  militate  against  madness 
being  an  arterial  disease,  it  would  prove  too  much, 
for  we  sometimes  discover  the  same  morbid  ap- 
pearances, which  produced  apoplexy  and  palsy, 
to  be  present  in  the  brain  after  death,  without  any 
of  the  common  symptoms  of  those  diseases  hav- 
ing been  preceded  by  them. 

Many  other  organic  diseases  are  occasionally 
devoid  of  their  usual  characteristic  symptoms. 
Neither  vomiting,  nor  want  of  appetite,  have 
taken  place  in  stomachs  in  which  mortification 
has  been  discovered  after  death :  and  abscesses 
have  been  found  in  the  livers  of  persons,  who  have 
died  without  any  one  of  the  common  symptoms 
of  hepatitis.  By  allowing  the  same  latitude  to  the 
«  confused  and  irregular  operations  of  nature."  in 


OF  THE  MIND.  27 

the  brain,  in  the  production  of  madness,  that  we 
observe  in  the  production  of  all  the  other  dis- 
eases that  have  been  mentioned,  we  can  reconcile 
its  occasional  absence,  with  the  existence  of  all 
the  organic  affections  in  the  brain  which  usually 
produce  it 

In  reviewing  the  numerous  proofs  of  madness, 
being  seated  primarily  in  the  blood-vessels,  and 
its  being  accompanied  so  generally  with  most  of 
the  symptoms  of  fever,  we  can  not  help  being 
struck  with  the  histories  of  the  disease  that  have 
been  given  by  many  ancient  and  modern  physi- 
cians. Galen  defines  it  to  be  "delirium  sine 
febre."  Aritaeus  says  it  is  "  semper  sine  febre." 
Dr.  Arnold  quotes  a  group  of  authors,  who  have 
adopted  and  propagated  the  same  error.  Even 
Dr.  Heberden  admits  and  reasons  upon  it.  The 
antiquity  and  extent  of  this  error  should  lead  us 
never  to  lose  sight  of  the  blood-vessels  in  investi- 
gating the  causes  of  diseases.  They  are,  to  a 
physician,  what  the  meridian  sun  is  to  a  mariner. 
There  are  but  few  diseases  in  which  it  will  be 
possible  for  him  to  preserve  the  system  in  a  heal- 
thy course,  without  daily,  and  often  more  frequent 
observations  of  the  state  of  the  blood-vessels,  as 
manifested  by  the  different  and  varying  states  of 
the  pulse. 


28  ON  THE  DISEASES 


CHAPTER  II. 


OF  the  remote  and  existing  causes  of  intellectual 
derangement. 

I  have  combined  both  these  classes  of  causes, 
inasmuch  as  they  most  commonly  act  in  concert, 
or  in  a  natural  succession  to  each  other.  In  en- 
umerating them,  I  shall  include  such  as  act  alike 
in  producing  partial  and  universal  madness. 

They  have  been  divided,  l,into  such  as  act, 
directly  upon  the  body;  and,  2,  such  as  act  indi- 
rectly upon  the  body,  through  the  medium  of  the 
mind. 

To  the  first  head  belong,  1,  all  those  causes 
which  act  directly  upon  the  brain.  These  are,  1, 
malconformation  and  Isesions  of  the  brain.  Be- 
tween the  latter,  and  the  existence  of  madness, 
there  is  sometimes  an  interval  of  several  years. 
A  young  man  died  in  the  Pennsylvania  Hospital 
in  the  year  1809,  who  became  deranged  at  twenty- 


OF  THE  MIND.  29 

one,  in  consequence  of  a  contusion  on  his  head 
by  a  fall  from  a  horse  in  the  fifteenth  year  of  his 

age.     A  Mr. died  of  madiess  in  the  same 

place,  from  an  injury  done  to  his  brain  by  being 
thrown  out  of  his  chair,  between  two  and  three 
years  before  he  discovered  any  signs  of  derange- 
ment. It  is  remarkable  that  injuries  show  them- 
selves more  slowly  in  the  brain  than  in  other  parts 
of  the  body.  Dr.  Lettsome  mentions  a  case,  in 
the  Memoirs  of  the  London  Medical  Society,  of  a 
disease  in  the  brain,  induced  by  a  fall  from  a 
horse,  which  did  not  discover  itself  until  two  and 
twenty  years  after  its  occurrence. 

2.  Certain  local  disorders,  induced  by  enlarge- 
ment of  the  bone,  tumours,  abscesses,  and  water 
in  the  brain. 

3.  Certain  diseases  of  the  brain,  particularly 
apoplexy,    palsy,    epilepsy,    vertigo,    and    head- 
ach.     It  occurs  but  rarely  from  the  last  of  these 
causes. 

4.  Insolation.     Two  cases   of  madness   from 
this  cause  occurred  under  my  care  between  July 
1807,  and  February  1808. 

5.  Certain  odours.     There  is  a  place  in  Scot- 


30  ON  THE  DISEASES 

land  where  madness  is  sometimes  induced  by  the 
fumes  of  lead.  Patients  who  are  affected  with  it 
bite  their  handsf|  and  tear  their  flesh  upon  the 
other  parts  of  their  bodies.  It  is  called  by  the 
country  people  mill-reck.  Dr.  Prost  describes  a 
furious  grade  of  madness  in  Peru,  brought  on  by 
a  mineral  exhalation,  but  he  does  not  mention  the 
metal  from  which  it  is  derived.  From  among 
many  other  facts  that  might  be  mentioned,  to 
show  the  connection  of  odours  with  a  morbid 
state  of  the  mind,  I  shall  mention  one  more.  An 
ingenious  dyer,  in  this  city,  informed  me  that  he 
often  observed  the  men  who  were  employed  in 
dying  blue,  of  which  colour  indigo  is  the  basis,  to 
become  peevish,  and  low-spirited,  and  never  even 
to  hum  a  tune,  while  engaged  at  their  work. 

There  are  certain  causes  which  induce  mad- 
ness, by  acting  upon  the  brain  in  common  with 
the  whole  body.  These  are,  1,  gout,  dropsy,  con- 
sumption, pregnancy,  and  fevers  of  all  kinds. 

2.  Inanition  from  profuse  evacuation,  or  from  a 
defect  of  nourishment.    Famine  induces  it  in  part 
from  the  latter  cause. 

3.  The    sudden    abstraction   of  the   stimulus 
of  distention.     When  madness  follows  parturi- 


OP  THE  MIND.  31 

tion,  it  is    most  commonly   derived   from    this 
cause. 

4.  The  excessive  use  of  ardent  spirits.     During 
the  time  Dr.  Nicholas  Waters  acted  as  resident 
physician  and   apothecary   of  the   Pennsylvania 
Hospital,  he  instituted  an  inquiry,  at  my  request, 
into  the  proportion  of  maniacs  from  this  cause, 
who    were    confined    in    the    Hospital.      They 
amounted  to  one-third  of  the  whole  number. 

5.  Inordinate  sexual  desires  and  gratifications. 
Several  cases  of  madness  from  this  cause  have 
come  under  my  notice. 

6.  Onanism.     Four  cases  of  madness  occurred, 
in  my  practice,  from  this  cause,  between  the  years 
1804  and  1807.     It  is  induced  more  frequently  by 
this  cause  in  young  men,  than  is  commonly  sup- 
posed by  parents  and  physicians.     The  morbid 
effects  of  intemperance  in  a  sexual  intercourse 
with  women  are  feeble,  and  of  a  transient  nature, 
compared  with  the  train  of  physical  and  moral 
evils  which  this  solitary  vice  fixes  upon  the  body 
and  mind. 

7.  The  transfusion  of  blood  from  one  animal 
into  the  blood-vessels  of  another.     This  practice 


32  ON  THE  DISEASES 

was  employed  in  France  many  years  ago,  in 
order  to  discover  a  method  of  restoring  health, 
and  renovating  life,  in  sick  and  aged  people.  All 
the  persons,  Dionis  tells  us,  who  were  the  sub- 
jects of  it,  died  in  a  state  of  derangement.  The 
practice  was  founded  in  error;  for  old  age  and 
sickness  are  occasioned  by  exhausted  or  diseased 
solids,  and  not  by  any  unfitness  in  the  quality  of 
the  blood,  to  support  animal  life. 

8.  Great  pain. 

9.  Unusual  labour  or  exercise. 

10.  Extremely  hot  and  cold  weather. 

3.  Madness  is  induced  by  corporeal  causes, 
which  act  sympathetically  upon"  the  brain.  These 
are,  1,  certain  narcotic  substances,  particularly 
opium,  hemlock,  night-shade,  hen-bane,  and  acco- 
nitum,  taken  into  the  stomach. 

2.  The  suppression  of  any  usual  evacuation, 
such  as  the  menses,  lochia,  milk,  semen  or  blood 
from  the  hemorrhoidal  vessels. 

3.  Worms  in  the  alimentary  canal. 


OF  THE  MIND.  33 

4.  Irritation  from  certain  foreign  matters  re- 
tained in  irritable  parts  of  the  body.  1  once  knew 
some  small  shot  which  were  lodged  in  the  foot  of  a 
school-boy,  induce  madness  several  years  after  he 
became  a  man.  It  has  been  brought  on  in  one 
instance  by  decayed  teeth,  which  were  not  ac- 
companied with  pain. 

4.  Madness  is  sometimes  induced  by  what  is 
called  a  metastasis  of  some  other  disease  to  the 
brain.  These  diseases  are,  1,  dropsy.  A  case  of 
madness  from  this  cause  is  related  by  Dr.  Mead. 
2.  Consumption.  All  the  symptoms  of  this  dis- 
ease sometimes  suddenly  disappear,  in  conse- 
quence of  the  translation  of  morbid  excitement  to 
the  brain. 

3.  St.  Vitus's  dance.    I  attended  a  young  lady 
some  years  ago,  in  whom  this  disease  was  sus- 
pended by  an  attack  of  madness.     Her  madness 
passed  out  of  her  brain,  through  the  same  chan- 
nel by  which  it  entered  it,  that  is,  in  convulsions 
in  the  limbs  of  one  side,  which  gradually  yielded 
to  the  power  of  medicine. 

4.  Hysteria.     The  morbid  commotions  in  the 
nervous  system  are  sometimes  transferred  to  the 


34  ON  THE  DISEASES 

blood-vessels  and  the  brain,  where  they  induce 
transient  or  chronic  madness. 

5.  Certain  cutaneous   eruptions.     The  son  of 
Dr.  Zimmerman  became  deranged  in  consequence 
of  an  eruption  being  repelled  from  his  skin.     I 
attended  a  private   patient  in  the  Pennsylvania 
Hospital,  in  whom  madness  was  induced  by  the 
same  cause.     The  healing  of  an  old  and  habitual 
ulcer  has  sometimes  produced  the  same  effect. 

6.  The   measles.     A    young  man,  of  sixteen 
years  of  age,  was  admitted  into  the  Pennsylvania 
Hospital,  in  June  1812,  in  a  high  state  of  derange- 
ment, which  followed  this  disease. 

II.  The  causes  which  induce  intellectual  de- 
rangement, by  acting  upon  the  body  through  the 
medium  of  the  mind,  are  of  a  direct  and  indirect 
nature. 

The  causes  which  act  directly  upon  the  under- 
standing are, 

1.  Intense  study,  whether  of  the  sciences  or  of 
the  mechanical  arts,  and  whether  of  real  or  im- 
aginary objects  of  knowledge.  The  latter  more 


OP  THE  MIND.  35 

frequently  produce  madness  than  the  former. 
They  are,  chiefly,  the  means  of  discovering  per- 
petual motion ;  of  converting  the  base  metals  into 
gold,  of  prolonging  life  to  the  antediluvian  age ; 
of  producing  perfect  order  and  happiness  in  mo- 
rals and  government,  by  the  operations  of  human 
reason ;  and,  lastly,  researches  into  the  meaning 
of  certain  prophecies  in  the  Old  and  New  Testa- 
ments. 1  think  I  have  observed  madness  from  the 
last  cause,  to  arise  most  frequently  from  an  at- 
tempt to  fix  the  precise  time  in  which  those  pro- 
phecies were  to  be  fulfilled,  or  from  a  disappoint- 
ment in  that  time,  after  it  had  passed. 

2.  The  frequent  and  rapid  transition  of  the 
mind  from  one  subject  to  another.  It  is  said 
booksellers  have  sometimes  become  deranged 
from  this  cause.  The  debilitating  effects  of  these 
sudden  transitions  upon  the  mind,  are  sensibly 
felt  after  reading  a  volume  of  reviews  or  maga- 
zines. The  brain  in  these  cases  is  deprived  of 
the  benefit  of  habit,  which  prevents  fatigue  to 
a  certain  extent,  from  all  the  exercises  of  the 
body  and  mind,  when  they  are  confined  to  single 
objects. 

It  is  worthy  of  notice,  that  this  cause  of  mad- 
ness accords  exactly  with  a  symptom  of  one  of  its 


36  ON  THE  DISEASES 

forms,  and  that  is,  a  constant  and  rapid  transition 
of  the  mind  to  a  variety  of  unrelated  subjects. 
But  the  understanding  is  affected  chiefly  in  an 
indirect  manner. 

"•r 

1.  Through  the  medium  of  the  imagination. 
It  is  conveyed  into  the  understanding  from  this 
faculty,  in  all  those  people  who  became  deranged 
from  inordinate  schemes  of  ambition  or  avarice. 
Mad-houses  in  every  part  of  the  world,  exhibit 
instances  of  persons   who  have  become  insane 
from  this  cause.     The  great  extent  and  constant 
exercises  of  the  imagination  in  poets,  accounts 
for  their  being  occasionally   affected  with  this 
disease. 

2.  The  understanding  is  sometimes   affected 
with  madness  through  the  medium  of  the  me- 
mory.    Dr.  Zimmerman   relates   the  case  of  a 
Swiss  clergyman,  in  whom  derangement  was  in- 
duced by  undue  labour  in  committing  his  sermons 
to  memory. 

3.  But  madness  is  excited  in  the  understanding 
most  frequently  by  impressions  that  act  primarily 
upon  the  heart.     I  shall  enumerate  some  of  these 
impresssions,  and   afterwards   mention   such  in- 
stances of  their  morbid  effects  as  I  have  met  with 


OP  THE  MIND.  37 

in  the  course  of  my  reading  and  observations. 
They  are  joy,  terror,  love,  fear,  grief,  distress, 
shame  from  offended  delicacy,  defamation,  ca- 
lumny, ridicule,  absence  from  native  country,  the 
loss  of  liberty,  property,  and  beauty,  gaming,  and 
inordinate  love  of  praise,  domestic  tyranny,  and 
lastly,  the  complete  gratification  of  every  wish  of 
the  heart. 

Extravagant  joy  produced  madness  in  many  of 
the  successful  adventurers  in  the  South-Sea  spe- 
culation in  England,  in  the  year  1720. 

Charles  the  Sixth,  of  France,  was  deranged 
from  a  paroxysm  of  anger. 

Terror  has  often  induced  madness  in  persons 
who  have  escaped  from  fire,  earthquakes  and 
shipwreck.  Two  cases,  from  the  last  cause,  have 
occurred  under  my  notice. 

Where  is  the  mad-house  that  does  not  contain 
patients  from  neglected,  or  disappointed  love  f 

Fear  often  produced  madness,  Dr.  Brambilla 
tells  us,  in  new  recruits  in  the  Austrian  army. 


38  ON  THE  DISEASES 

Grief  induced  madness,  which  continued  fifty 
years,  in  a  certain  Hannah  Lewis,  formerly  a 
patient  in  the  Pennsylvania  Hospital. 

Distress  often  produced  this  disease,  Mr.  How- 
ard tells  us,  in  the  prisoners  of  the  town  of  Liege. 

An  exquisite  sense  of  delicacy,  Dr.  Burton  says, 
produced  madness  in  a  school-master,  who  was 
accidentally  discovered  upon  a  close-stool  by  one 
of  his  scholars. 

The  Bedlams  of  Europe  exhibit  many  cases  of 
madness  from  public  and  private  defamation,  and 
history  informs  us  of  ministers  of  state  and  gene- 
rals of  armies  having  often  languished  away  their 
lives  in  a  state  of  partial  derangement,  in  conse- 
quence of  being  unjustly  dismissed  by  their  sove- 
reigns. 

A  player  destroyed  himself  in  Philadelphia,  in 
the  year  1803,  soon  after  being  hissed  off  the 
stage. 

The  Swiss  soldiers  sometimes  languish  and  die 

o 

from  that  form  of  madness  which  is  brought  on 
by  absence  from  their  native  country. 


OF  THE  MIND. 


39 


An  ingenious  modern  poet  mentions  this  dis- 
ease, as  well  as  its  exciting  cause,  with  peculiar 
elegance. 

"  The  intrepid  Swiss  that  guards  a  foreign  shore, 
"  Condemn'd  to  climb  his  mountain-clifFs  no  more, 
"  If  chance  he  hear  the  song,  so  sweetly  wild, 
"  Which,  on  those  cliffs,  his  infant  hours  beguil'd, 
"  Melts  at  the  long  lost  scenes,  that  round  him  rise, 
"  And  sinks  a  martyr  to  repentant  sighs." 

It  is  remarkable,  that  this  disease  is  most  com- 
mon among  the  natives  of  countries  that  are  the 
least  desirable  for  beauty,  fertility,  climate,  or  the 
luxuries  of  life.  They  resemble,  in  this  respect, 
in  their  influence  upon  the  human  heart,  the  arti- 
ficial objects  of  taste  which  are  at  first  disagreea- 
ble, but  which  from  habit  take  a  stronger  hold 
upon  the  appetite  than  such  as  are  natural  and 
agreeable. 

The  Africans  become  insane,  we  are  told,  in 
some  instances,  soon  after  they  enter  upon  the 
toils  of  perpetual  slavery  in  the  West  Indies. 

Hundreds  have  become  insane  in  consequence 
of  unexpected  losses  of  money.  It  is  remarkable 
this  disease  occurs  oftener  among  the  rich,  who 
lose  only  a  part  of  their  property,  than  among 


40  ON  THE  DISEASES 

persons   in  moderate  circumstances,  who    lose 
their  all. 

An  American  Indian  became  deranged,  and 
destroyed  himself,  in  consequence  of  seeing  his 
face  in  a  looking  glass  soon  after  his  recovery 
from  a  violent  attack  of  the  small-pox.  The 
loss  of  one  eye,  by  an  affray  in  a  country  tavern, 
which  materially  affected  the  beauty  of  the  face, 
produced  derangement  in  a  young  man  who  was 
afterwards  my  patient  in  the  Pennsylvania  Hos- 
pital. There  are  other  facts,  which  show  the 
depth  of  this  attachment  to  beauty  in  the  human 
mind,  and  the  poignancy  of  the  distress  occa- 
sioned by  its  loss  or  decay.  The  once  beautiful 
lady  Mary  Wortley  Montague  tells  a  friend,  in 
one  of  her  letters,  that  she  had  not  seen  herself 
in  a  looking  glass  for  eleven  years,  solely  from 
her  inability  to  bear  the  mortifying  contrast  be- 
tween her  appearance  in  the  two  extremes  of  her 
life. 

A  clergyman  in  Maryland  became  insane  in 
consequence  of  having  permitted  some  typo- 
graphical errors  to  escape  in  a  sermon  which 
he  published  upon  the  death  of  general  Wash- 
ington. 


OP  THE  MIND.  41 

The  son  of  a  late  celebrated  author  in  England 
became  deranged  in  consequence  of  the  severe 
treatment  he  received  from  his  father  in  the 
course  of  his  education.  Several  instances  of 
madness,  induced  by  the  cruel  or  unjust  conduct 
of  schoolmasters  and  guardians  to  the  persons 
who  were  the  subjects  of  their  power  and  care, 
are  to  be  met  with  in  the  records  of  medicine. 

Sir  Philip  Mordaunt  shot  himself  immediately 
after  succeeding  to  a  great  estate,  and  to  the  fa- 
vour of  his  prince,  and  while  he  appeared  to  be 
in  possession  of  every  thing  that  could  constitute 
the  plenitude  of  human  happiness.  The  eldest 
son  of  a  Scotch  nobleman,  of  high  rank  and  large 
fortune,  destroyed  himself  in  the  same  way,  a  few 
weeks  after  the  consummation  of  all  his  worldly 
prospects  and  enjoyments,  by  his  marriage  to  a 
most  accomplished  and  amiable  young  lady. 

Two  instances  are  upon  record,  of  persons  who 
destroyed  themselves  immediately  after  drawing 
high  prizes  in  a  lottery.  In  all  these  cases  death 
was  the  effect  of  derangement. 

4.  The  understanding  is  sometimes  deranged 

6 


42  ON  THE  DISEASES 

through  the  medium  of  the  moral  faculties.  A 
conscience  burdened  with  guilt,  whether  real  or 
imaginary,  is  a  frequent  cause  of  madness.  The 
latter  produces  it  much  oftener  than  the  former. 

An  instance  of  insanity  occurred  in  a  married 
woman  in  this  city  some  years  ago,  of  the  most 
exemplary  character,  from  a  belief  that  she  had 
been  unfaithful  to  the  marriage  bed.  An  accident 
discovered  that  the  supposed  criminal  connection 
was  with  a  man  whose  very  person  was  unknown 
to  her.  There  is  further  a  morbid  sensibility  in 
the  conscience  in  some  people,  that  predisposes 
to  madness  from  the  most  trifling  causes.  A 
young  man,  of  great  piety,  died  of  this  disease  in 
our  Hospital  a  few  years  ago,  in  consequence  of 
his  believing  that  he  had  offended  his  Maker  by 
refusing  to  say  grace  at  the  table  of  a  friend. 

The  most  distressing  grade  of  derangement  un- 
der this  head  is,  where  real  guilt,  and  a  diseased 
imagination  concur  in  producing  it.  The  occa- 
sional act  of  self-mutilation  which  deranged  pa- 
tients sometimes  inflict  upon  themselves,  and  the 
painful  and  protracted  austerities  voluntarily  im- 
posed upon  the  body  in  Catholic  countries,  ap- 


OF  THE  MIND.  43 

pear  to  be  the  effects  of  the  combined  operation 
of  these  two  causes  upon  the  understanding. 

But  we  sometimes  observe  intellectual  de- 
rangement to  occur  from  the  moral  faculties  be- 
ing unduly  excited  by  supposed  visions  and 
revelations,  instances  of  which  will  be  mentioned 
in  another  place. 

Let  not  religion  be  blamed  for  these  cases  of 
insanity.  The  tendency  of  all  its  doctrines  and 
precepts  is  to  prevent  it  from  most  of  its  mental 
causes ;  and  even  the  errors  that  have  been 
blended  with  it,  produce  madness  less  frequently 
than  love,  and  many  of  those  common  and  neces- 
sary pursuits,  which  constitute  the  principal  en- 
joyments and  business  of  life. 

To  the  history  of  the  causes  of  derangement 
which  has  been  given,  I  shall  add,  that  that  form 
of  it  which  has  been  called  hypochondriasis,  is 
sometimes  induced  without  either  the  patient  or 
his  friends  being  able  to  ascribe  it  to  any  cause. 
Dr.  Nicholas  Robinson,  a  physician  who  lived  in 
the  beginning  of  the  last  century,  complains,  in  a 
treatise  which  he  has  published  upon  melancholy, 
of  his  sufferings  from  it  in  the  following  words : 


44  ON  THE  DISEASES 

"When  no  air  has  blown  across  my  affairs,  and 
no  shade  obscured  my  sun,  then  am  I  most  mis- 
erable." I  have  heard  similar  declarations  from 
several  of  my  patients,  and  particularly  from  a 
clergyman  of  the  most  exemplary  life  and  con- 
versation. In  all  such  cases,  it  would  be  absurd 
to  suppose  the  disease  existed  without  a  cause. 
Many  diseases  take  place  in  the  body  from  causes 
that  are  forgotten,  or  from  sympathies  with  parts 
of  the  body  that  are  supposed  to  be  in  a  healthy 
state.  In  like  manner,  depression  of  mind  may 
be  induced  by  causes  that  are  forgotten ;  or  by 
the  presence  of  objects  which  revive  the  sensa- 
tion of  distress  with  which  it  was  at  one  time 
associated,  but  without  reviving  the  cause  of  it 
in  the  memory.  The  former  pupils  of  the  author 
will  recollect  several  instances  of  mental  plea- 
sure, as  well  as  pain,  from  association,  mentioned 
by  him  in  his  physiological  lectures  upon  the 
mind,  in  which  the  original  causes  of  both  had 
perished  in  the  memory. 

Intellectual  derangement  is  more  common  from 
mental  than  corporeal  causes.  Of  113  patients 
in  the  Bicetre  Hospital  in  France,  at  one  time, 
Mr.  Pinel  tolls  us  34  were  from  domestic  misfor- 
tunes, 24  from  disappointments  in  love,  30  from 
the  distressing  events  of  the  French  Revolution, 


OF  THE  ftflND.  45 

and  25  from  what  he  calls  fanaticism,  making  in 
all  the  original  number.  I  have  taken  pains  to 
ascertain  the  proportion  of  mental  and  corporeal 
causes  which  have  operated  in  producing  mad- 
ness in  the  Pennsylvania  Hospital,  but  I  am  sorry 
to  add,  my  success  in  this  inquiry  was  less  satis- 
factory than  I  wished.  Its  causes  were  con- 
cealed in  some  instances,  and  forgotten  in  others. 
Of  fifty  maniacs,  the  causes  of  whose  diseases 
were  discovered  by  Dr.  Moore  and  his  assistant, 
Mr.  Jenny,  in  the  month  of  April,  1812,  7  were 
from  disappointments,  chiefly  in  love;  7  from 
grief;  7  from  the  loss  of  property;  5  from  er- 
roneous opinions  in  religion;  2  from  jealousy;  1 
from  terror;  1  from  insolation;  1  from  an  injury 
to  the  head ;  2  from  repelled  eruptions ;  5  from 
intemperance ;  3  from  onanism  ;  2  from  pregnan- 
cy; and  1  from  fever;  making  in  all  34  from 
mental,  and  16  from  corporeal  causes.  A  pre- 
disposition to  the  disease  was  hereditary  in  but 
five  of  them. 

I  shall  now  mention  all  those  circumstances  in 
birth,  certain  peculiarities  of  the  body,  age,  sex, 
condition  and  rank  in  life,  intellect,  occupation, 
climate,  state  of  society,  forms  of  government, 
revolutions,  and  religion,  which  predispose  the 


46  ON  THE  DISEASES 

body  and  mind  to  be  acted  upon  by  the  remote 
and  exciting  causes  that  have  been  mentioned,  so 
as  to  favour  the  production  of  madness. 

I.  A  peculiar  and  hereditary  sameness  of  or- 
ganization of  the  nerves,  brain  and  blood-ves- 
sels, on  which  I  said  formerly  the  predisposition 
to  madness  depended,  sometimes  pervades  whole 
families,  and  renders  them  liable  to  this  dis- 
ease, from  a  transient  or  feeble  operation  of  its 
causes. 

Application  was  made  some  years  ago  for  the 
admission  of  three  members  of  the  same  family 
into  the  Pennsylvania  Hospital  on  the  same  day. 
I  have  attended  two  ladies,  one  of  whom  was  the 
fourth,  and  the  other  the  ninth,  of  their  respective 
families,  that  had  been  affected  with  this  disease 
in  two  generations. 

The  following  letter  to  the  author,  from  Dr. 
Stephen  W.  Williams,  of  Deerfield,  in  Massachu- 
setts, contains  the  history  of  two  cases  ol  here- 
ditary madness,  which,  from  the  singular  resem- 
blance in  their  subjects,  symptoms,  and  issue, 
have  seldom  perhaps  been  met  with  in  the  re- 
cords of  medicine. 


OP  THE  MIND.  47 

JunelGth,  1812. 
DEAR  SIR, 

"  Believing  that i  the  science  of  medicine  is  re- 
lated to  every  thing,'  I  am  induced  to  transmit  to 
you  the  following  incidents  which  have  lately  oc- 
curred in  the  vicinity  of  this  place,  hoping  that 
some  useful  inductions  may  be  drawn  from  them, 
for  the  benefit  of  our  profession. 

"  Captains  C.  L.  and  J.  L.  were  twin  brothers, 
and  so  great  was  the  similarity  in  their  coun- 
tenances and  appearance,  that  it  was  extremely 
difficult  for  strangers  to  know  them  apart.  Even 
their  friends  were  often  deceived  by  them.  Their 
habits  and  manners  were  likewise  similar.  Many 
ludicrous  stories  are  told  of  people  mistaking  one 
for  the  other. 

"  They  both  entered  the  American  revolution- 
ary army  at  the  same  time.  Both  held  similar 
commissions,  and  both  served  with  honour  during 
the  war.  They  were  cheerful,  sociable,  and  in 
every  respect  gentlemen.  Thoy  were  happy  in 
their  families,  having  amiable  wives  and  children, 
and  they  were  both  independent  in  their  proper- 
ty. Some  time  after  the  close  of  the  war,  cap- 
tain J.  removed  to  the  state  of  Vermont,  while 


48  ON  THE  DISEASES 

captain  C.  remained  in  Greenfield,  in  the  vicini- 
ty of  Deerfield,  and  200  miles  from  his  brother. 
Within  the  course  of  three  years,  they  have  both 
been  subject  to  turns  of  partial  derangement,  but 
by  no  means  rising  into  mania,  nor  sinking  into 
melancholy.  They  appeared  to  be  hurried  and 
confused  in  their  manners,  but  were  constantly 
able  to  attend  to  their  business.  About  two  years 
ago,  captain  J,  on  his  return  from  the  general  as- 
sembly of  Vermont,  of  which  he  was  a  member, 
was  found  in  his  chamber,  early  in  the  morning, 
with  his  throat  cut,  by  his  own  hand,  from  ear  to 
ear,  shortly  after  which  he  expired.  He  had  been 
melancholy  a  few  days  previous  to  this  fatal  ca- 
tastrophe, and  had  complained  of  indisposition 
the  evening  previous  to  the  event. 

"  About  ten  days  ago,  Captain  C.  of  Greenfield, 
discovered  signs  of  melancholy,  and  expressed  a 
fear  that  he  should  destroy  himself.  Early  in  the 
morning  of  June  fifth  he  got  up,  and  proposed 
to  his  wife  to  take  a  ride  with  him.  He  shaved 
himself  as  usual,  wiped  his  razor,  and  stepped 
into  an  adjoining  room,  as  his  wife  supposed, 
to  put  it  up.  Shortly  after  she  heard  a  noise,  like 
water  or  blood  running  upon  the  floor.  She  hur- 
ried into  the  room,  but  was  too  late  to  save  him. 


OF  THE  MIND.  49 

He  had  cut  his  throat  with  his  razor,  and  soon 
afterwards  expired. 

"The  mother  of  these  two  gentlemen,  an  aged 
lady,  and  their  two  sisters,  the  only  survivors  of 
their  family,  have  been  subject,  for  several  years, 
to  the  same  complaint." 

There  are  several  peculiarities  which  attend 
this  disease,  where  the  predisposition  to  it  is 
hereditary,  which  deserve  our  notice. 

1.  It  is  excited  by  more  feeble  causes  than  in 
persons  in  whom  this   predisposition  has  been 
acquired. 

2.  It  generally  attacks  in  those  stages  of  life  in 
which  it  has  appeared  in  the  patient's  ancestors. 
A  general  officer,  who  served  in  the  American 
army  during  the  revolutionary  war,  once  expressed 
a  wish  to  a  brother  officer,  from  whom  I  received 
the   information,  "that  he  might  not  live  to  be 
old,  that  he  might  die  suddenly,  and  that  if  he 
married,  he  might  have  no  issue."     Upon  being 
asked  the  reason  for  these  wishes,  he  said,  he  was 
descec-ded  from  a  family  in  which  madness  had 
sometimes  appeared  about  the  fiftieth  year  of  life, 
and  that  he  did  not  wish  to  incur  the  chance  of 

7 


50  ON  THE  DISEASES 

inheriting,  and  propagating  it  to  a  family  of  chil- 
dren. He  was  gratified  in  all  his  three  wishes. 
He  fell  in  battle  between  the  thirtieth  and  fortieth 
years  of  his  age,  and  he  left  no  issue,  although  he 
had  been  married  several  years  before  his  death. 
A  similar  instance  of  the  disease  appearing  at 
the  same  time  of  life,  in  three  persons  of  the 
same  family,  occurred  under  my  notice  in  the 
Pennsylvania  Hospital.  It  came  on  in  a  father 
and  his  two  sons  between  the  sixtieth  and  seven- 
tieth years  of  their  lives.  . 

3.  Children  born  previously  to  the  attack  of 
madness  in  their  parents  are  less  liable  to  inherit 
it  than  those  who  are  born  after  it. 

4.  Dr.  Burton,  in  his  Anatomy  of  Melancholy, 
remarks,  that  children  born  of  parents  who  are  in 
the  decline  of  life,  are  more  predisposed  to  one 
of  the  forms  of  partial  insanity  than  children  born 
under  contrary  circumstances. 

5.  A  predisposition  to  certain  diseases  seated 
in  parts  contiguous  to  the  seat  of  madness,  often 
descends  from  parents  to  their  children. — Thus 
we  sometimes  see  madness  in  a  son  whose  father 
or  mother  had  been  afflicted  only  with  hysteria, 
or  habitual  headach.    The  reverse  of  this  remark 


OF  THE  MIND.  51 

likewise  sometimes  takes  place.  I  attended  a 
respectable  mechanic  in  this  city  in  two  attacks 
of  madness,  the  last  of  which  terminated  his  life. 
All  his  children,  six  in  number,  and  now  all  adults, 
are  afflicted  with  headach,  but  none  of  them  have 
ever  discovered  any  sign  of  madness  in  their  con- 
duct or  conversation. 

6.  There  are  instances  of  families  in  which 
madness  has  existed,  where  the  disease  has  pass- 
ed by  the  understanding  in  their  posterity,  and 
appeared  in  great  strength  and  eccentricity  of  the 
memory  and  of  the  passions,  or  in  great  perver- 
sion of  their  moral  faculties.  Sometimes  it  passes 
by  all  the  faculties  of  the  mind,  and  appears  only 
in  the  nervous  system,  in  persons  descended  from 
deranged  parents ;  again  we  see  madness  in  chil- 
dren whose  parents  were  remarkable  only  for 
eccentricity  of  mind. 

There  are  several  diseases  which  attack  the 
children  of  the  same  family,  which  did  not  exist  in 
their  ancestors.  I  have  called  them  filial  dis- 
eases. They  are  chiefly  consumption  and  epi- 
lepsy. I  have  attempted  to  discover  whether 
madness  never  appears  in  this  way,  and  have 
heard  of  but  two  instances  of  it.  One  of  them 
occurred  in  a  family  on  the  Island  of  Barbadoes, 


52  ON  THE  DISEASES 

in  which  four  children,  descended  from  parents  of 
habitual  sound  minds,  became  deranged.  Per- 
haps in  these  cases  the  disease  had  existed  in 
their  remote  ancestors,  or  possibly  it  was  trans- 
lated from  a  disease  in  some  of  the  contiguous 
systems  of  the  body.  I  have  wished  to  discover 
whether  there  be  any  peculiarity  of  shape  in  the 
skulls  of  mad  people  that  are  predisposed  to  de- 
rangement, for  which  purpose  I  requested  Dr. 
Vandyke,  in  the  year  1810,  to  examine  the  dimen- 
sions of  the  heads  of  all  the  insane  patients  in  our 
hospital,  in  several  different  directions,  and  after- 
wards to  measure  in  the  same  way  the  heads  of  a 
number  of  patients  belonging  to  the  hospital, 
with  other  diseases.  The  result  of  this  inquiry 
was  a  discovery  that  there  was  no  departure  but 
in  one  instance  from  the  ordinary  and  natural 
shape  of  the  head,  in  between  sixty  and  seventy 
mad  people. 

II.  A  predisposition  to  madness  is  said  to  be 
connected  with  dark  coloured  hair.  Mr.  Haslam 
informs  us  that  this  was  the  case  in  two  hundred 
and  five  out  of  two  hundred  and  sixty-five  patients 
in  the  Bethlehem  Hospital.  He  intimates  that  it 
was  possibly  from  their  consisting  chiefly  of  the 
natives  of  England,  in  whom  that  colour  of  the 
hair  is  very  general ;  but  the  same  connection 


OF  THE  MIND.  53 

between  madness  and  dark  colour  has  been  dis- 
covered in  the  maniacs  in  the  Pennsylvania  Hos- 
pital, who  consist  of  persons  from  three  or  four 
different  countries,  or  of  descendants  who  inherit 
their  various  physical  characters.  Of  nearly 
seventy  patients,  who  were  examined  at  my  re- 
quest, by  Dr.  Vandyke,  in  our  Hospital,  in  the 
year  1810,  with  a  reference  to  this  fact,  all, 
except  one,  had  dark-coloured  hair.  In  the 
month  of  April,  1812,  I  requested  Dr.  Vandyke  to 
direct  his  inquiries  more  particularly  to  the  colour 
of  the  eyes  in  the  maniacal  patients  in  our  hos- 
pital. He  executed  my  request  with  great  care 
and  correctness,  and  discovered  that  fifty-six  out 
of  seventy-nine  of  them  had  light-coloured  eyes, 
of  which  number  but  six  had  fair  hair. 

III.  There  is  a  greater  predisposition  to  mad- 
ness between  twenty  and  fifty,  than  in  any  of  the 
previous  or  subsequent  years  of  human  life.     Of 
the  correctness  of  this  remark,  Mr.  Pinel  has  fur- 
nished us  with  the  following  proof.     Of  1201  per- 
sons who  were  admitted  into  the  Bicetre  Hospital 
in  France,  between  the  years  1784  and  1794,  955 
were  between  the  two  ages  that  have  been  men 
tioned,  65  were  between  fifteen  and  twenty,  131 
were  between  fifty  and  sixty,  and  51  between  sixty 
and  seventy-one.     Mr.  Haslam  has  furnished  ad- 


54  ON  THE  DISEASES 

ditional  evidence  of  the  correctness  of  this  re- 
mark. Of  1664  deranged  patients  who  were 
admitted  into  the  Bethlehem  Hospital  in  London, 
between  the  years  1784  and  1794,  he  tells  us  910 
of  them  were  between  the  ages  mentioned  by  Mr. 
Pinel.  But  the  proportion  of  maniacal  patients, 
above  twenty  and  under  fifty  years  of  age,  was 
much  greater  in  the  Pennsylvania  Hospital  in  the 
month  of  April,  1812.  It  was  ascertained  by  Dr. 
Vandyke  to  be  68  out  of  79,  that  is,  nearly  seven- 
eighths  of  their  whole  number.  From  the  state 
of  the  body  and  mind  within  those  periods,  it  is 
easy  to  account  for  this  being  the  case.  The 
blood-vessels  and  the  nerves  are  then  in  a  highly 
excitable  state,  and  the  former  readily  assume 
morbid  or  inflammatory  action  from  the  remote 
and  exciting  causes  of  disease.  The  mind  too, 
within  those  years,  possesses  more  sensibility,  and 
of  course  is  more  easily  acted  upon  by  mental 
irritants,  the  sources  of  which,  from  family  afflic- 
tions, and  disappointments  in  the  pursuits  of  busi- 
ness, pleasure  and  ambition,  are  more  numerous 
in  those  years,  than  in  any  of  the  previous  or  sub- 
sequent stages  of  life. 

Madness,  it  has  been  said,  seldom  occurs  under 
puberty.  To  the  small  number  of  instances  of 
it,  that  are  upon  record,  I  shall  add  four  more. 


OP  THE  MIND.  55 

Two  boys,  the  one  of  eleven  and  the  other  of 
seven  years  of  age,  were  admitted  into  our  Hos- 
pital with  this  disease  (the  latter  during  the  time 
of  my  attendance  in  1799)  and  both  discharged 
cured.  I  have  since  seen  an  instance  of  it  in  the 
year  1803,  in  a  child  of  two  years  old,  that  had 
been  affected  with  cholera  infantum ;  and  another 
in  a  child  of  the  same  age,  in  the  year  1808,  that 
was  affected  with  internal  dropsy  of  the  brain. 
They  both  discovered  the  countenance  of  mad- 
ness, and  they  both  attempted  to  bite,  first  their 
mothers,  and  afterwards  their  own  flesh.  The 
reason  why  children  and  persons  under  puberty 
are  so  rarely  affected  with  madness,  must  be  as- 
cribed to  mental  impressions,  which  are  its  most 
frequent  cause,  being  too  transient  in  their  effects, 
from  the  instability  of  their  minds  to  excite  their 
brains  into  permanently  diseased  actions.  It  is 
true,  children  are  often  affected  with  delirium,  but 
this  is  a  symptom  of  general  fever,  which  is  always 
induced,  like  the  few  cases  of  madness  in  children 
that  I  have  mentioned,  only  by  corporeal  causes. 

From  the  records  of  the  Bicetre  Hospital,  in 
France,  it  appears  that  madness  rarely  occurs  in 
old  age.  Doleus  and  Dr.  Greding,  mention  seve- 
ral cases  of  it;  the  latter  in  a  man  of  eighty-five. 
I  have  attended  two  men  between  sixty  and  seven- 


56 


ON  THE  DISEASES 


ty,  and  one  woman  between  seventy  and  eighty,  in 
the  Pennsylvania  Hospital,  and  a  private  patient  in 
the  eighty-first  year  of  his  age,  in  this  disease.    It 
has  been  said  that  maniacs  seldom  live  to  be  old. 
I  have  known  but  few  exceptions  to  this  remark, 
and  they  were  of  persons  in  whom  the  extinction  of 
the  mind,  in  idiotism,  had  protected  the  body  from 
being  worn  out  prematurely  by  its  constant  and 
preternatural  excitement  or  depression.     One  of 
the  persons  was  Hannah  Lewis,  formerly  men- 
tioned, in  whom  the  disease  was  induced  by  grief, 
in  middle  life,  from  the  loss  of  her  husband.     She 
died  in  our  Hospital  in  the  year  1799,  in  the  eighty- 
seventh  year  of  her  age.      A  predisposition  to 
longevity,  which  she  derived  from  her  ancestors, 
predominated  over  the  tendency  of  her  long  pro- 
tracted disease  to  destroy  her  life.     She  lost  one 
sister  in  the  eighty-second  year  of  her  age,  and  at 
the  time  of  her  death  had  another  living  who  was 
ninety-four,  neither  of  whom  had  ever  been  affect- 
ed with   madness.     There  are  two  reasons  why 
this  disease  so  rarely  attacks  old  people.     Their 
blood-vessels  lose  their  vibratility  from  age,  and 
hence  they  are  less  liable  to  fevers  than  in  middle 
life;  and  from  the  diminution  of  sensibility  in  their 
nerves  an'd  brains,  the  causes  of  madness  make 
but  a  feeble  and  transient  impression  upon  their 
minds.     In  the  latter  condition  of  their  bodies, 


OF  THE  MIND.  57 

they  revert  to  that  state  which  takes  place  in  chil- 
dren, and  which  I  have  said  protects  them  from 
the  frequent  occurrence  of  this  disease. 

V.  Women,  in  consequence  of  the  greater  pre- 
disposition imparted  to  their  bodies  by  menstrua- 
tion, pregnancy,   and   parturition,    and  to  their 
minds,  by  living  so  much  alone  in  their  families, 
are  more  predisposed  to  madness  than  men.     A 
woman  was  admitted  into  our  Hospital   many 
years   ago,  who   was  deranged  only  during  the 
time  of  her  menstruation,  and  who  in  one  of  those 
periods,  hung  herself  with  the  string  of  her  petti- 
coat.    Of  1664  patients  admitted  into  the  Beth- 
lehem Hospital,  between  the  years  1784  and  1794, 
eighty-four  of  them  were  women  in  whom  mad- 
ness followed  parturition.     I  have  been  consulted 
in  two  cases,  and  I  have  heard  of  a  third,  in  which 
madness  was  induced  by  the  solitude  of  a  coun- 
try life,  in  women  who  had  been  accustomed  to 
live  in  a  large  social  and  domestic  society.     Of 
8874  patients  admitted  into  the  Bethlehem  Hos- 
pital in  London,  between   the  years  1748,   and 
1794,  four  thousand  eight  hundred  and  thirty-two 
were  women;  nearly  a  fifth  more  than  men.     In 
St.  Luke's  Hospital  in  London,  the  proportion  of 
women  to  men  who  have  been  admitted  in  a  given 
number  of  years,  is  in  the  ratio  of  three  to  two. 

8 


58  ON  THE  DISEASES 

But  this  disproportion  of  women  to  men,  who  are 
affected  with  madness,  is  by  no  rneans  universal. 
In  a  Hospital  for  mad  people  in  Vienna,  one  hun- 
dred and  seventeen  men  were  admitted  in  a  given 
number  of  years,  and  but  ninety-four  women.  In 
a  Hospital  of  the  same  kind  at  Berlin,  twice  as 
many  males  were  admitted  in  a  given  time  as  fe- 
males. More  of  the  former  than  of  the  latter 
have  been  admitted  into  the  Pennsylvania  Hospi- 
tal. In  all  these  cases  accidental  circumstances, 
such  as  the  want  of  accommodations  suited  to  fe- 
male delicacy,  or  deep  rooted  prejudices  against 
public  mad-houses,  and  a  preference  of  such  as 
are  private,  may  have  lessened  the  proportion  of 
women  in  the  above  instances,  while  the  evils  of 
war,  bankruptcy,  and  habits  of  drinking,  which 
affect  men  more  than  women,  and  which  vary  in 
their  influence  upon  the  mind  in  different  coun- 
tries, may  have  produced  more  instances  of  mad- 
ness in  the  former  than  in  the  latter  sex.  Perhaps 
it  would  be  correct  to  say,  women  are  more  sub- 
ject to  madness  from  natural  causes,  and  men 
from  such  as  are  artificial. 

What  has  been  said  under  this  head,  applies 
more  particularly  to  general  madness;  but,  from 
many  facts,  I  am  led  to  believe  that  men  are  more 
subject  to  that  grade  of  derangement,  which  has 


OF  THE  MIND.  59 

been  called  hypochondriasm,  than  women.     The 
distressing  impressions  made  upon  the  minds  of 
women  frequently  vent  themselves  in  tears,  or  in 
hysterical  commotions  in  the  nervous  system  and 
bowels,   while   the   same   impressions  upon   the 
minds  of  men  pass  by  their  more  compact  ner- 
vous and  muscular  fibres,  and  descend  into  the 
brain,  and  thus  more  frequently  bring  on  hypo- 
chondriac insanity.     If  this  remark  be  correct,  it 
will  confirm  Dr.  Heberden's  assertion,  that  men 
are  more  disposed  to  suicide  than  women,  for  it 
necessarily  follows  their  being  most  subject  to 
that  state  of  madness.     Where  the  instances  of 
suicide  are  more  frequent  among  women  than 
men,  it  is  in  those  cases  only  in  which  the  former 
are  exposed  to  sudden  paroxysms  of  vexation  and 
despair. 

VI.  Single  persons  are  more  predisposed  to 
madness  than  married  people.  Of  seventy-two 
insane  patients  in  the  Pennsylvania  Hospital, 
whose  condition  relative  to  this  question  was  as- 
certained by  my  young  friends,  Dr.  Moore  and  Mr. 
Jenny,  in  the  month  of  April  1812,  forty-two  had 
never  been  married,  and  five  were  widows  and 
widowers,  at  the  time  they  became  deranged. 

The  absence  of  real  and  present  care,  which 
give  the  mind  leisure  to  look  back  upon  past,  and 


60  ON  THE  DISEASES 

to  anticipate  future  and  imaginary  evils,  and  the 
inverted  operation  of  all  the  affections  of  the  heart 
upon  itself,  together  with  the  want  of  relief  in  con- 
jugal sympathy  from  the  inevitable  distresses  and 
vexations  of  life,  and  for  which  friendship  is  a  cold 
and  feeble  substitute,  are  probably  the  reasons  why 
madness  occurs  more  frequently  in  single,  than  in 
married  people.  Celibacy,  it  has  been  said,  is  a 
pleasant  breakfast,  a  tolerable  dinner,  but  a  very 
bad  supper.  The  last  comparison  will  appear  to 
be  an  appropriate  one,  when  we  consider  further, 
that  the  supper  is  not  only  a  bad  quality,  but 
eaten  alone.  -No  wonder  it  sometimes  becomes 
a  predisposing  cause  of  madness. 

VII.  The  rich  are  more  predisposed  to  madness 
than  the  poor,  from  their  exposing  a  larger  surface 
of  sensibility  to  all  its  remote  and  exciting  causes. 
Even  where  mental  sensibility  is  the  same  in  both 
those  classes  of  people,  the  disease  is  prevented 
in  the  latter,  by  the  constant  pressure  of  bodily 
suffering,  from  labour,  cold,  and  hunger.     These 
present  evils  defend  their  minds  from  such  as  are 
past  and  anticipated ;  and  these  are  the  principal 
causes  of  madness.     When  it  occurs  in  poor  peo- 
ple, it  is  generally  the  effect  of  corporeal  causes. 

VIII.  "  Great  wit,  and  madness,"  are  said  by 
Dryderi  "  to  be  nearly  allied."     If  he  meant  by 


OP  THE  MIND.  61 

this,  affinity  between  wit  and  madness,  the  rapid 
exercises  of  the  mind  in  associating  similar  and 
dissimilar  ideas  of  words  which  are  peculiar  to 
both,  the  remark  is  a  correct  one ;  but  if  he  meant 
that  great  wits  are  more  predisposed  to  madness 
than  other  people,  the  remark  is  opposed  by  all 
that  is  known  of  the  solidity  of  understanding,  and 
correctness  of  conversation  and  conduct  of  Butler, 
Chesterfield,  Franklin,  Johnson,  and  many  other 
distinguished  men  who  possessed  the  talent  of  wit 
in  an  eminent  degree.  Nor  is  the  remark  true  if 
the  term  wit  be  intended  to  designate  men  of  great 
understandings.  Their  minds  are  sometimes  worn 
away  by  intense  and  protracted  study,  but  they 
are  rarely  perverted  by  madness.  The  vigorous 
mind  of  Dean  Swift  perished  gradually  only  from 
the  former  cause.  Where  madness  has  been  in- 
duced by  intense  and  protracted  application  to 
books,  it  has  generally  been  in  persons  of  weak 
intellects,  who  were  unable  to  comprehend  the 
subjects  of  their  studies. 

IX.  Certain  occupations  predispose  to  mad- 
ness more  than  others.  Pinel  says,  poets,  painters, 
sculptors  and  musicians,  are  most  subject  to  it, 
and  that  he  never  knew  an  instance  of  it  in  a  chy- 
mist,  a  naturalist,  a  mathematician,  or  a  natural 
philosopher.  The  reason  of  this  will  be  under- 
stood by  recollecting  what  was  said  under  the 


62 


ON  THE  DISEASES 


preceding  head.     The  ^studies  of  the  former  exer- 
cise the  imagination,  and  the  passions,  while  the 
studies  of  the  latter  interest  the   understanding 
only.     Dr.  Arnold  tells  us,  he  has  observed  me- 
chanics to  be  more  affected  with  madness  than 
merchants  and  members  of  the  learned  profes- 
sions.    This  may  arise  from  the  vague  and  dis- 
tracting exertions  of  genius,  unassisted  by  educa- 
tion; or  from  corporeal  causes,  to  which  their 
employments  expose  them  more  than  the  classes 
of  men  that  have  been  mentioned.     Of  the  effects 
of  the  former  of  those  causes,  I  once  saw   an 
instance  in  a  house-carpenter,  who  became  de- 
ranged in  consequence  of  an  unsuccessful  attempt 
to  contrive  a  new  kind  of  staircase.  More  farmers, 
it  has  been  said,  become  deranged  than  persons 
of  the  same  grade  of  intellect  and  independence 
in  cities.     If  this  be  the  case,  it  must  be  ascribed 
to  the  greater  solitude  of  their  lives,  more  espe- 
cially in  the  winter  season,  and  to  their  being  more 
exposed  from  labour  and  accidents,  to  its  corpo- 
real causes. 

X.  Certain  climates  predispose  to  madness. — 
It  is  very  uncommon  in  such  as  are  uniformly 
warm.  Dr.  Gordon  informed  me  in  his  visit 
to  Philadelphia  in  the  year  1807,  that  he  had 
never  seen  nor  heard  of  a  single  case  of  madness 
during  a  residence  of  six  years  in  the  province  of 


OF  THE  MIND.  63 

Berbice.  It  is  a  rare  disease  in  the  West  Indies. 
While  great  and  constant  heat  increases  the  irri- 
tability of  the  muscles,  it  gradually  lessens  the 
sensibility  of  the  nerves  and  mind,  and  the  irrita- 
bility of  the  blood-vessels,  and  in  these  I  formerly 
supposed  the  predisposition  to  madness  to  be 
seated.  It  is  more  common  in  climates  alter- 
nately warm  and  cold,  but  most  so  in  such  as  are 
generally  moist  and  cold,  and  accompanied  at 
the  same  time  with  a  cloudy  sky.  Instances  of  it 
are  said  to  be  most  frequent  in  England  in  the 
month  of  November,  at  which  time  the  weather 
is  unusually  gloomy  from  the  above  causes.  Even 
the  transient  occurrence  of  that  kind  of  weather 
in  the  United  States,  has  had  an  influence  upon 
this  disease.  In  the  month  of  May  in  the  year 
1806,  it  prevailed  to  a  great  degree,  during  which 
time  three  patients  in  the  Pennsylvania  Hospital 
made  unsuccessful  attempts  upon  their  lives,  and  a 
fourth  destroyed  himself.  Two  instances  of  sui- 
cide occurred  in  the  same  month  in  Philadelphia. 

XL  Certain  states  of  society,  and  certain  opi- 
nions, pursuits,  amusements,  and  forms  of  govern- 
ment, have  a  considerable  influence  in  predis- 
posing to  derangement.  It  is  a  rare  disease 
among  savages.  Baron  Humboldt  informed  me, 
that  he  did  not  hear  of  a  single  instance  of  it 


64 


ON  THE  DISEASES 


among  the  uncivilized  Indians  in  South  America. 
Infidelity  and  atheism  are  frequent  causes  of  it  in 
Christian    countries.     In   commercial  countries, 
where  large  fortunes  are  suddenly  acquired  and 
lost,  madness  is  a  common  disease.    It  is  most 
prevalent  at  those  times  when  speculation  is  sub- 
stituted to  regular  commerce.     The  mad-houses 
in  England  were  crowded  with  patients  before, 
and  after  the  bursting  of  the  South  Sea  bubble  in. 
the  year  1720.     In   the  United  States,  madness 
has  increased  since  the  year  1790.   This  must  be 
ascribed  chiefly  to  an  increase  in  the  number  and 
magnitude  of  the  objects  of  ambition  and  avarice, 
and  to  the  greater  joy  or  distress  which  is  pro- 
duced by  gratification  or  disappointments  in  the 
pursuit  of  each  of  them.     The  funding  system, 
and  speculations  in  bank-scrip,  and  new  lands, 
have   been   fruitful  sources   of  madness   in   our 
country.     Sixteen  persons  perished  from  suicide 
in  the  city  of  New  York,  in  the  year  1804,  inmost 
of  whom  it  was   supposed   to   be  the  effect  of 
madness,  from  the  different  and  contrary  events 
of  speculation. 

Even  the  profit  and  losses  of  regular  trade  and 
agricultural  labour,  now  and  then  pervert  the 
understanding.  A  respectable  merchant  died  of 
madness  in  the  Pennsylvania  Hospital,  in  the 


OP  THE  MIND.  65 

year  1794,  induced  by  a  successful  East  India 
voyage.     A  farmer,  near  Albany,  who  refused  to 
take  twenty  shillings  a  bushel  for  a  large  quantity 
of  wheat,  in  the  year  1798,  became  insane  from 
the  sudden  reduction  of  its  price.     Suicide  was 
induced  in   a  farmer  of  great  wealth,  in  York 
county,  in  Pennsylvania,  in  the  spring  of  1812,  by 
a  similar  disappointment,  in  obtaining  a  less  price 
than  he  had  been  previously  offered  for  a  quanti- 
ty of  clover  seed.      Gaming  is   an   occasional 
cause  of  madness  in  some  countries.     At  Penang 
in  the  East  Indies,  where  men  often  stake  their 
wives  upon  the  issue  of  a  game,  this  disease  is 
very  common.     The  unfortunate  gambler  often 
rises  from  his  seat  in  a  fit  of  derangement,  and 
sallies  out  into  the  street  with  instruments  of  mur- 
der in  his  hands  ;  a  bell  is  rung  at  this  time,  which 
drives  people  into  their  houses,  to  avoid  being 
killed.     A  late  German  writer  has  remarked,  that 
nervous  diseases  increase  in  the  cities  of  Ger- 
many in  proportion  to  the  fondness  of  their  citi- 
zens for  seeing  tragedies.     It  is  easy  to  conceive 
they  may  extend  their  effects  a  little  further,  so  as 
to  excite  morbid  commotions  in  the  blood-vessels 
of  the  brain.     I  have  heard  the  greater  frequency 
of  madness  in  England,  than  in  some  other  coun- 
tries, ascribed  in  part  to  its  inhabitants  preferring 
tragedy  to  comedy  in  their  stage  entertainments. 

9 


66  ON  THE  DISEASES 

The  real  emotions  excited  by  these  exhibitions  of 
imaginary  distress,  are  never  accompanied  with 
an  effort  to  relieve  it,  by  which  means  there  is  an 
accumulation  and  reflux  of  sensation  in  the  mind, 
that  cannot  fail  of  affecting  the  nerves  arid  brain, 
and  thereby  to  predispose  to,  or  induce  madness. 
Certain  forms  of  government  predispose  to  mad- 
ness. They  are  those  in  which  the  people  pos- 
sess a  just  and  exquisite  sense  of  liberty,  and  of 
the  evils  of  arbitrary  power,  against  which  com- 
plaints are  stifled  by  a  military  force.  The  con- 
flicting tides  of  the  public  passions,  by  their  ope- 
ration upon  the  understanding,  become  in  these 
cases  a  cause  of  derangement.  The  assassina- 
tion of  tyrants  and  their  instruments  of  oppres- 
sion, is  generally  the  effect  of  this  disease.  That 
madness  is  thus  induced,  I  infer  from  its  occurring 
so  rarely  from  a  political  cause  in  the  United 
States.  I  have  known  but  one  instance  of  it,  and 
that  was  in  a  gentleman  who  had  been  deranged 
some  years  before  from  debt,  contracted  by  ex- 
travagant living.  In  a  government  in  which  all 
the  power  of  a  country  is  representative  and  elec- 
tive, a  day  of  general  suffrage,  and  free  presses, 
serve,  like  chimnies  in  a  house,  to  conduct  from 
the  individual  and  public  mind,  all  the  discontent, 
vexation,  and  resentment,  which  have  been  gen- 
erated in  the  passions,  by  real  or  supposed  evils, 


OF  THE  MIND.  67 

and  thus  to  prevent  the  understanding  being  in- 
jured by  them. 

In  despotic  countries,  where  the  public  pas- 
sions are  torpid,  and  where  life  and  property  are 
secured  only  by  the  extinction  of  the  domestic 
affections,  madness  is  a  rare  disease.  Of  the 
truth  of  this  remark  I  have  been  satisfied  by  Mr. 
Stewart,  the  pedestrian  traveller,  who  spent  some 
time  in  Turkey;  also  by  Dr.  Scott,  who  accom- 
panied lord  M'Cartney  in  his  embassy  to  China; 
and  by  Mr.  Joseph  Roxas,  a  native  of  Mexico, 
who  passed  nearly  forty  years  of  his  life  among 
the  civilized  but  depressed  natives  of  that  coun- 
try. Dr.  Scott  informed  me  that  he  heard  of 
but  a  single  instance  of  madness  in  China,  and 
that  was  in  a  merchant  who  had  suddenly  lost 
100,000/.  sterling  by  an  unsuccessful  speculation 
in  gold  dust. 

Mr.  Carr,  in  his  Northern  Summer,  tells  us, 
that  madness  is  an  uncommon  disease  in  Russia. 
It  is  a  rare  thing,  says  this  professional  traveller, 
to  see  a  Russian  peasant  angry.  He  even  per- 
suades and  reasons  with  his  horse,  when  he  wishes 
him  to  quicken  his  gait.  It  is  to  the  long  pro- 
tracted civil  and  ecclesiastical  tyranny  of  the  late 
government  of  Spain,  that  we  must  ascribe  the 


68  ON  THE  DISEASES 

small  number  of  maniacs  in  all  the  hospitals  in 
that  country.  They  amounted,  according  to  Mr. 
Townsend,  in  the  year  1786,  to  but  664,  in  a 
population,  which  produces  in  Great  Britain  be- 
tween 4,000  and  5,000;  2,600  of  whom  are  in 
the  city  and  neighbourhood  of  London.  Habits 
of  oppression  in  all  those  cases  expend  the  ex- 
citability of  the  passions,  and  prevent  their  re- 
acting upon  the  brain.  But  in  some  instances 
the  understanding  decays  with  the  passions,  in 
despotic  countries.  This  state  of  the  mind  has 
been  called  fatuity.  It  is  very  common  in  Turkey 
and  China.  The  inirritable  or  non-elastic  state 
of  the  brain  upon  which  this  disorder  depends,  is 
induced  in  those  countries  without  previous  mor- 
bid excitement,  in  the  same  manner  that  the 
disorder  called  hepatalgia  is  induced,  without 
previous  hepatisis  or  obvious  and  sensible  in- 
flammation in  the  liver,  in  the  East  and  West 
Indies. 

XII.  Revolutions  in  governments  which  are 
often  accompanied  with  injustice,  cruelty,  and 
the  loss  of  property  and  friends,  and  where  this  is 
not  the  case,  with  an  inroad  upon  ancient  and 
deep-seated  principles  and  habits,  frequently  mul- 
tiply instances  of  insanity.  Mr.  Volney  informed 
me,  in  his  visit  to  this  city  in  the  year  1799,  that 


OF  THE  MIND.  69 

there  were  three  times  as  many  cases  of  madness 
in  Paris  in  the  year  1795,  as  there  were  before 
the  commencement  of  the  French  Revolution. 
It  was  induced,  I  shall  say  hereafter,  in  several 
instances,  by  the  events  of  the  American  Revolu- 
tion. 

XIII.  Different  religions,  and  different  tenets  of 
the  same  religion,  are  more  or  less  calculated  to 
induce  a  predisposition  to  madness.  Dr.  Sheb- 
beare  says  there  are  fewer  instances  of  suicide 
(which  is  generally  the  effect  of  madness)  in 
catholic,  than  in  protestant  countries.  He  as- 
cribes it  to  the  facility  with  which  the  catholics 
relieve  their  minds  from  the  pressure  of  guilt,  by 
means  of  confession  and  absolution.  This  asser- 
tion, and  the  reasoning  founded  upon  it,  are  ren- 
dered doubtful  by  150  suicides  having  taken  place 
in  the  catholic  city  of  Paris  in  the  year  1782,  and 
but  32  in  the  same  year  in  the  Protestant  city  of 
London.  It  is  probable,  however,  the  greater 
portion  of  infidels  in  the  former,  than  in  the  latter 
city  at  that  time,  may  have  occasioned  the  dif- 
ference in  the  number  of  deaths  in  the  two 
places,  for  suicide  will  naturally  follow  small  de- 
grees of  insanity,  where  there  are  no  habits  of  mo- 
ral order  from  religion,  and  no  belief  in  a  future 
state.  Dr.  Shebbeare's  assertion  is  rendered  still 


70  ON  THE  DISEASES 

less  probable,  by  considering  the  usual  effects  of 
solitude  upon  the  human  mind,  and  this  we  know 
acts  with  peculiar  force  in  the  cells  of  monks  and 
nuns.  This  remark  is  not  the  result  of  reasoning 
a  priori.  Of  between  240  and  250  deranged  peo- 
ple, who  were  confined  at  one  time  in  a  mad-house, 
in  the  city  of  Mexico,  Mr.  Roxas  informed  me,  in 
a  great  majority  of  them  the  disease  had  been 
contracted  in  those  recluse  and  gloomy  situations. 

There  are  certain  tenets  held  by  several  pro- 
testant  sects  of  Christians  which  predispose  the 
mind  to  derangement.  They  shall  be  noticed  in 
another  place. 

I  shall  conclude  the  history  of  the  remote  excit- 
ing and  predisposing  causes  of  madness  by  the 
following  remarks. 

J.  Its  remote  causes  generally  induce  predis- 
posing debility.  Its  exciting  causes  more  com- 
monly induce  that  morbid  excitement  in  the  blood- 
vessels of  the  brain  in  which  madness  is  seated, 
but  the  sudden  and  violent  action  of  a  remote 
cause  is  often  sufficient  for  that  purpose  without 
the  aid  of  an  exciting  cause. 

2.  Both  the  remote  and  exciting  causes  of  mad- 


OF  THE  MIND.  71 

ness  produce  their  morbid  effects  more  certainly, 
promptly  or  slowly,  according  as  the  system  is 
more  or  less  predisposed  to  the  disease  by  the 
causes  formerly  mentioned. 

3.  The  predisposing  causes  of  madness  some- 
times act  with  so   much  force,  as  to  induce  it 
without  the  perceptible  co-operation  of  either  a 
remote  or  an  exciting  cause.   The  remote  causes 
of  madness  likewise  act  with  so  much  force  in 
some  instances,  as  to  induce  it  without  the  per- 
ceptible  co-operation  of  a  predisposing  or  ex- 
citing cause. 

4.  The  predisposing  causes  of  madness  in  like 
manner  sometimes  act  with  so  much  force  as  to 
induce  it  without  the  perceptible  co-operation  of 
a  remote  or  an  exciting  cause. 


72 


ON  THE  DISEASES 


CHAPTER  III. 

Of  Partial  Intellectual  Derangement,  and  particularly 
of  Hypochondriasis. 

PARTIAL  derangement  consists  in  error  in  opi- 
nion and  conduct,  upon  some  one  subject  only, 
with  soundness  of  mind  upon  all,  or  nearly  all 
other  subjects.     The  error  in  this  case  is  two- 
fold.    It  is  directly  contrary  to  truth,  or  it  is  dis- 
proportioned  in  its   effects   or  expected   conse- 
quences, to  the  causes  which  induce  them.     It 
has  been  divided  by  the  nosologists  according  to 
its   objects.     When   it  relates   to    the    persons, 
affairs,  or  condition  of  the  patient  only,  and  is 
attended  with  distress,  it  has  been  called  hypo- 
chondriasis.     When  it  extends  to  objects  exter- 
nal to  the  patient,  and  is  attended  with  pleasure, 
or  the  absence  of  distress,  it  has   been   called 
melancholia.     They  are  different  grades  only  of 
the  same  morbid  actions  in  the  brain,  and  they 
now  and  then  blend  their  symptoms  with  each 
other. 


OF  THE  MIND.  73 

I  wish  I  could  substitute  a  better  term  than 
hypochondriasis,  for  the  lowest  grade  of  derange- 
ment. It  is  true  the  hypochondriac  region  is  dis- 
eased in  it ;  so  it  is  after  autumnal  fevers,  and  yet 
we  do  not  designate  the  obstructions  induced  by 
those  fevers  by  that  name.  It  would  be  equally  pro- 
per to  call  every  other  form  of  madness  hypo- 
chondriasm,  for  they  are  all  attended  with  more  or 
less  disease  or  disorder  in  the  liver,  spleen,  sto- 
mach, and  bowels,  from  which  the  name  of hypo- 
chodriasm  is  derived.  But  I  have  another  objec- 
tion to  that  name,  and  that  is,  it  has  unfortunately 
been  supposed  to  imply  an  imaginary  disease 
only,  and  when  given  to  the  disease  in  question,  is 
always  offensive  to  patients  who  are  affected  with 
it.  It  is  true,  it  is  seated  in  the  mind :  but  is  as 
much  the  effect  of  corporeal  causes  as  a  pleurisy, 
or  a  bilious  fever.  Perhaps  the  term  TRISTIMANIA 
might  be  used  to  express  this  form  of  madness 
when  erroneous  opinions  respecting  a  man's  per- 
son, affairs,  or  condition,  are  the  subjects  of 
his  distress. 

I  object  likewise  to  the  term  melancholia,  when 
used,  as  it  is  by  Dr.  Cullin,  to  express  partial 
madness  from  external  causes. 

10 


74 


ON  THE  DISEASES 


1.  Because  it  is  sometimes  induced  by  causes 
that  are  not  external  to  the  patient,  but  connected 
with  his  person,  affairs,  or  condition  in  life  ;  and, 

2.  Because   it  conveys   an   idea  of  its  being 
seated  in  the  liver  and  derived  from  vitiated  or 
obstructed   bile.     Now  the  seat  of  the  disease, 
from  facts  formerly  mentioned,  appears  to  be  in 
the  brain,  and  morbid  or  obstructed  bile  is  evi- 
dently an  accidental  symptom  of  it.     Perhaps  it 
would  be  more  proper  to  call  it  AMENOMANIA,  from 
the  errors  that  constitute  it,  being  generally  at- 
tended with  pleasure,  or  the  absence  of  distress. 

The  hypochondriasis,  or  tristimania,  has  some- 
times been  confounded  with  hysteria,  but  differs 
from  it, 

1.  In  being  induced  chiefly  by  mental  causes, 
and  particularly  by  such  of  them  as  act  upon  the 
understanding,  through  the  medium  of  the  pas- 
sions and  moral  faculties.  Histeria  is  produced 
chiefly  by  corporeal  causes.  Its  paroxysms  only 
are  excited  by  such  as  are  mental.  The  chronic 
operation  of  the  passions,  so  far  from  inducing  it, 
sometimes  cures  it,  or  changes  it  into  hypochon- 
driasm. 


OF  THE  MIND.  75 

2.  In  affecting  men  more  than  women. 

3.  In  affecting  chiefly  persons  of  sedentary 
employments. 

4.  In  the  absence  of  globus  hystericus. 

5.  In  affecting  the  blood-vessels  of  the  brain  as 
well  as  the  nerves.     Hysteria  affects  the  nerves 
and  muscles  only,  and  never  the  blood-vessels,  so 
as  to   produce  derangement,  except  for  a  short 
time,  and  only  during  its  paroxysms. 

6.  The   nerves   in   hypochondriasis    are   in   a 
reverse  state  from  that  which  takes  place  in  hys- 
teria.    In  the  former  they  are  torpid,  or  in  what 
Themison  calls  a  strictum  state.    In  the  latter  dis- 
ease they  are  highly  excitable,  or  what  the  same 
author   has  called  a  laxum  state.     These  terms 
correspond  with  what  Dr.  Boerhaave  has  since 
denominated  a  rigid  and  lax  state  of  the  fibres. 

7.  Hypochondriasis  is  generally  attended  with 
costiveness  or  diarrhoea,  and  durable  distress  of 
mind,  which  are  transient  affections  only  in  hys- 
teria; and, 


t 

76  ON  THE  DISEASES 

8.  Hypochondriasis  is  relieved  by  warm  weather 
and  warm  drinks.  Hysteria  is  made  worse  by 
each  of  them. 

Hypochondriasis,  or  tristimania,  is  to  hysteria 
what  a  typhus  fever  is  to  inflammatory  fever.  It 
is  often  combined  with  it,  and  sometimes  alter- 
nates with  it,  and,  when  cured,  it  passes  out  of  the 
system  with  symptoms  of  hysteria,  in  all  those 
cases  in  which  it  was  preceded  by  them.  I  beg 
the  attention  of  the  reader  to  this  view  of  these 
two  forms  of  disease.  It  is  intended  to  destroy 
the  nosological  distinctions  between  them.  As 
well  might  we  divide  the  first  and  last  stages  of  a 
fever  by  specific  characters,  as  divide  those  two 
grades  of  morbid  excitement  by  specific  names. 

I  shall  now  deliver  a  history  of  the  most  cha- 
racteristic symptoms  of  the  two  different  forms  of 
partial  derangement  that  have  been  mentioned, 
and  afterwards  take  notice  of  the  remedies  proper 
for  each  of  them.  I  shall  begin  with  hypochon- 
driasis  or  tristimania. 

The  symptoms  of  this  form  of  derangement  as 
they  appear  in  the  body  are,  dyspepsia ;  costive- 
ness  or  diarrhoaa,  with  slimy  stools;  flatulency 


OP  THE  MIND.  77 

pervading  the  whole  alimentary  canal,  and  called 
in  the  bowels  borborigini;  a  tumid  abdomen, 
especially  on  the  right  side ;  deficient  or  preterna- 
tural appetite ;  strong  venereal  desires  accompa- 
nied with  nocturnal  emissions  of  semen ;  or  an 
absence  of  venereal  desires,  and  sometimes  im- 
potence ;  insensibility  to  cold ;  pains  in  the  limbs 
at  times,  resembling  rheumatism;  cough;  cold 
feet;  palpitation  of  the  heart;  headach;  vertigo; 
tenitus  aurium;  a  thumping  like  a  hammer  in  the 
temples,  and  sometimes  within  the  brain ;  a  dis- 
position to  faint;  wakefulness,  or  starting  in  sleep; 
indisposition  to  rise  out  of  bed,  arid  a  disposition 
to  lie  in  it  for  days,  and  even  weeks ;  a  cool  and 
dry  skin,  and  frequently  of  a  sallow  colour,  from 
the  want  of  a  regular  discharge  of  bile  from  the 
liver,  and  its  absorption  into  the  blood. 

While  the  alimentary  canal  is  thus  depressed, 
and  the  blood-vessels,  nerves  and  muscles,  robbed 
of  nearly  all  their  excitement,  or  possess  it  in  parts 
of  the  body  only,  the  lymphatic  system  is  often 
preternaturally  excited ;  hence  we  frequently  ob- 
serve in  this  disease  a  constant  and  increased  dis- 
charge of  urine. 

The  characteristic  symptom  of  this  form  of  de- 
rangement, as  it  appears  in  the  mind,  is  distress, 


78  ON  THE  DISEASES 

the  causes  of  which  are  numerous,  and  of  a  per- 
sonal nature.  I  shall  enumerate  some  of  them, 
as  they  have  appeared  in  different  people.  They 
relate,  1,  to  the  patient's  body.  He  erroneously 
believes  himself  to  be  afflicted  with  various  dis- 
eases, particularly  with  consumption,  cancer, 
stone,  and  above  all,  with  impotence,  and  the 
venereal  disease.  Sometimes  he  supposes  him- 
self to  be  poisoned,  or  that  his  constitution  had 
been  ruined  by  mercury,  or  that  the  seeds  of  the 
hydrophobia  are  floating  in  his  system. 

2.  He  believes  that  he  has  a  living  animal  in 
his  body.  A  sea-captain,  formerly  of  this  city, 
believed  for  many  years  that  he  had  a  wolf  in 
his  liver.  Many  persons  have  fancied  they  were 
gradually  dying,  from  animals  of  other  kinds 
preying  upon  different  parts  of  their  bodies.  3. 
He  imagines  himself  to  be  converted  into  an  ani- 
mal of  another  species,  such  as  a  goose,  a  cock, 
a  dog,  a  cat,  a  hare,  a  cow,  and  the  like.  In  this 
case  he  adopts  the  noises  and  gestures  of  the 
animals  into  which  he  supposes  himself  to  be 
transformed. 

4.  He  believes  he  inherits,  by  transmigration, 
the  soul  of  some  fellow  creatures,  but  much 
oftener  of  a  brute  animal.  There  is  now  a  mad- 


OP  THE  MIND.  79 

man  in  the  Pennsylvania  Hospital  who  believes 
that  he  was  once  a  calf,  and  who  mentions  the 
name  of  the  butcher  that  killed  him,  and  the  stall 
in  the  Philadelphia  market  on  which  his  flesh 
was  sold  previously  to  his  animating  his  present 
body. 

5.  He  believes  he  has  no  soul.     The  late  Dr. 
Percival  communicated  to  me,  many  years  ago, 
an  account  of  a  dissenting  minister  in  England 
who  believed  that  God  had  annihilated  his  soul 
as  a  punishment  for  his  having  killed  a  high-way 
man  by  grasping  him  by  the  throat,  who  attempt- 
ed to  rob  him.     His  mind  was  correct  upon  all 
other  subjects. 

6.  He  believes  he  is  transformed  into  a  plant. 
In  the  Memoirs  of  the  Count  de  Maurepas  we  are 
told  this  error  took  possession  of  the  mind  of  one 
of  the  princes  of  Bourbon  to  such  a  degree,  that 
he  often  went  and  stood  in  his  garden,  where  he 
insisted  upon  being  watered  in  common  with  all 
the  plants  around  him. 

7.  The  patient  afflicted  with  this  disease  some- 
times fancies  he  is  transformed  into  glass. 


80  ON  THE  DISEASES 

8.  He  believes,  that  by  discharging  the  con- 
tents of  his  bladder,  he  shall  drown  the  world. 

9.  He  believes  himself  to  be  dead. 

It  is  worthy  of  notice,  in  all  these  cases  of 
erroneous  judgment,  the  patients  reason  correctly, 
that  is,  draw  just  inferences  from  their  errors. 
Thus  the  prince  of  Bourbon,  when  he  supposed 
himself  to  be  a  plant,  reasoned  justly  when  he 
insisted  upon  being  watered.  In  like  manner, 
the  hypochondriac  who  supposes  himself  to  be 
dead,  reasons  with  the  same  correctness  when  he 
stretches  his  body  and  limbs  upon  a  bed  or  a 
board,  and  assumes  the  stillness  and  silence  of 
the  shroud. 

It  is  remarkable  further,  that  all  the  erroneous 
opinions,  persons  affected  with  this  form  of  de- 
rangement entertain  of  themselves,  are  of  a 

o  ' 

degrading  nature. 

But  again.  The  distress  of  a  hypochondriac 
is  derived  from  errors  respecting,  1,  his  outward 
circumstances,  as  they  relate  to  his  property. 

2.  The  conduct  of  his  friends,  relations,  or  a 
mistress. 


OP  THE  MIND.  81 

3.  His  birth-place,  and  society  of  his  family, 
when  absent  from  them. 

4.  The  state  of  his  country. 

5.  His  spiritual  state. 

The  mind,  in  its  distress  from  all  the  above 
causes,  is  in  a  reverse  state  from  that  which  was 
just  now  mentioned,  in  drawing  erroneous,  or  dis- 
proportionate, conclusions  from  just  premises. 
Thus  the  hypochondriac  who  possesses  an  in- 
come which  he  admits  to  be  equal  to  all  the  exi- 
gencies of  his  family,  reasons  unjustly  when  he 
anticipates  ending  his  days  in  a  poor-house.  In 
like  manner  the  deranged  penitent  judges  cor- 
rectly when  he  believes  that  he  has  offended  his 
Maker,  but  he  reasons  incorrectly  when  he  sup- 
poses he  has  excluded  him  from  his  mercy. 

In  the  hypochondriasis  from  all  the  causes  that 
have  been  mentioned,  the  patients  are  for  a  while 
peevish  and  sometimes  irascible.  The  lightest 
noises,  such  as  the  grating  of  a  door  upon  its 
hinges,  or  its  being  opened  and  shut  suddenly, 
produce  in  them  anger  or  terror.  They  quarrel 
with  their  friends  and  relations.  They  change 

11 


82  ON  THE  DISEASES 

their  physicians  and  remedies,  and  sometimes 
they  discover  the  instability  of  their  tempers  by 
settling  and  unsettling  themselves  half  a  dozen 
times  in  different  parts  of  their  native  country,  or 
different  foreign  countries,  in  the  course  of  a  few 
years,  leaving  each  of  them  with  complaints  of 
their  climate,  provisions,  and  the  manners  of  their 
inhabitants. 

The  hypochondriasis,  or  tristimania,  like  most 
other  diseases,  has  paroxysms,  and  remissions  or 
intermissions,  all  of  which  are  influenced  by  many 
circumstances,  particularly  by  company,  wine, 
exercise,  and,  above  all,  the  weather. 

A  pleasant  season,  a  fine  day,  and  even  the 
morning  sun,  often  suspend  the  disease.  Mr. 
Cowper,  who  knew  all  its  symptoms  by  sad  expe- 
rience, bears  witness  to  the  truth  of  this  remark, 
in  one  of  his  letters  to  Mr.  Haley.  "I  rise,"  says 
he,  "cheerless  and  distressed,  and  brighten  as 
the  sun  goes  on."  Its  paroxysms  are  sometimes 
denominated  u  low  spirits."  They  continue  from 
a  day,  a  week,  a  month,  a  season,  to  a  year, 
and  sometimes  longer.  The  intervals  differ,  1, 
in  being  accompanied  with  preternatural  high 
spirits.  2.  In  being  attended  with  remissions 


OF  THE  MIND.  83 

only ;   and,  3,  with  intermissions,  or,   in   other 
words,  with  correctness  and  equanimity  of  mind. 

The  extremes  of  low  and  high  spirits  which 
occur  in  the  same  person,  at  different  times,  are 
happily  illustrated  by  the  following  case.  A  phy- 
sician in  one  of  the  cities  of  Italy  was  once  con- 
sulted by  a  gentleman,  who  was  much  distressed 
with  a  paroxysm  of  this  intermitting  state  of 
hypochondriasm.  He  advised  him  to  seek  relief 
in  convivial  company,  and  recommended  to  him 
in  particular  to 'find  out  a  gentleman  of  the  name 
of  Cardini,  who  kept  all  the  tables  in  the  city,  to 
which  he  was  occasionally  invited,  in  a  roar  of 
laughter.  "  Alas !  Sir,"  said  the  patient,  with  a 
heavy  sigh,  "I  am  that  Cardini."  Many  such 
characters,  alternately  marked  by  high  and  low 
spirits,  are  to  be  found  in  all  the  cities  in  the 
world. 

But  there  are  sometimes  flashes  of  apparent 
cheerfulness,  and  even  of  mirth,  in  the  intervals 
of  this  disease  which  are  accompanied  with  latent 
depression  of  mind.  This  appears  to  have  been 
the  case  in  Mr.  Cowper :  hence,  in  one  of  his  let- 
ters to  Mr.  Haley,  he  says,  "  I  am  cheerful  upon 
paper,  but  the  most  distressed  of  all  creatures." 


84  ON  THE  DISEASES 

It  was  probably  in  one  of  these  opposite  states  of 
mind  that  he  wrote  his  humorous  ballad  of  John 
Gilpin. 

In  the  history  of  hypochondriasm,  as  far  as  it 
has  been  given,  there  is  a  combination  of  some 
of  the  symptoms  of  hysteria,  from  the  nervous 
system  being  partially  or  alternately  in  a  strictum 
or  laxum,  or,  in  other  words,  in  an  inirritable  or 
irritable  state,  and  from  the  blood-vessels  being 
alternately  in  a  diseased  and  sound  state. 

This  mixture  of  the  symptoms  of  hypochon- 
driasis  and  hysteria,  in  these  two  opposite  states 
of  the  system,  is  described  with  great  accuracy  in 
the  following  letter  from  a  gentleman  in  Virginia, 
which  I  received  a  few  years  ago,  containing  the 
history  of  his  own  case. 

January  25,  1808. 
SIR, 

"  I  write  you  to  seek  relief  in  a  case  of  disease 
of  the  most  inveterate,  though  not  uncommon, 
nature.  It  is  a  nervous  affection  of  the  most 
obstinate  kind.  An  apathy  and  torpor  of  the 
bowels  and  stomach,  and  a  susceptibility  of  the 
mind  exceeding  all  description :  loss  of  sleep  to 


OP  THE  MIND. 


an  alarming  degree  at  times,  and  the  consequent 
debility,  despair,  subsultus  tendinum,  and  paraly- 
tic sensations  in  many  parts  of  my  body,  are  the 
principal  evils  I  suffer.  My  mind  is  liable  to  be 
excited  by  trifling  and  unsubstantial  causes ;  dis- 
posed to  cleave  to  unpleasant  usages,  to  dwell  on 
dreadful  consequences  from  really  trifling  circum- 
stances, to  be  appalled  with  vain  apprehensions, 
and  to  cherish  disgusts  and  disagreeable  associa- 
tions ;  indeed,  to  labour  under  a  fixidity  of  ideas 
which  causes  my  misery.  I  was  attacked  in  the 
winter  of  1800  and  1801,  and  since  that  time  have 
suffered  an  immensity  of  distress,  with  long  inter- 
vals, however,  of  capacity  for  enjoyment.  Moral 
causes  are  the  sources  of  my  afflictions.  The 
barriers  of  reason  are  cobwebs  to  oppose  to  the 
intrusion  of  this  host  of  enemies.  Am  I  in  a  con- 
vivial company  ?  I  think  of  some  unpleasant  cir- 
cumstance. Do  I  eat  heartily  ?  I  still  think ;  my 
mind  cannot  rise  above  its  customary  state  of 
feebleness.  When  I  lie  down,  this  fixed  image 
presents  itself.  I  am  distressed,  alarmed,  my  blood 
circulates  rapidly,  my  brain  is  fired,  a  train  of  dis- 
tressing ideas  enter  and  seize  my  mind ;  I  am,  as 
it  were,  all  nerve ;  the  least  noise  is  like  a  shock 
of  thunder,  so  that  for  seven  years  I  have  been  in 
the  constant  habit  of  stopping  both  ears  with  wax,* 
with  intervals,  however,  of  strength  to  bear  noise, 


86  ON  THE  DISEASES 

and  sometimes  even  1  am,  as  I  think,  almost  well. 
I  am  within  a  few  days  of  forty-four  years  of  age; 
my  appetite  is  always  good;  I  eat  every  thing, 
drink  moderately  of  wine,  have  found  no  good 
from  any  regimen,  though  I  have  not  pursued  any 
regimen  but  a  very  short  time. 

"  I  go  to  bed,  my  mind  is  distressed,  I  get  a  lit- 
tle quiet,  and  perhaps  I  am  disposed  to  rest ;  at 
the  moment  of  forgetfulness,  which  produces 
sound  sleep,  this  image  strikes  my  mind ;  I  know 
what  I  am  to  suffer;  am  alarmed;  my  blood 
rushes  through  the  jugular  vessels;  I  hear  my 
heart  beat,  and  feel  it  thumping  the  whole  night; 
my  mind  on  fire,  able  to  pursue  no  train  of  plea- 
sant thought  a  moment;  I  get  worse;  despair; 
think  of  nothing  but  my  wretched  condition,  till 
at  last  I  lose  several  nights  sleep ;  my  pulse  is  low 
and  threaded,  and  at  last  nature  makes  an  effort 
and  gradually  restores  me.  Such  is  almost  al- 
ways my  course. 

"I  can  assure  you  that  no  cause  of  distress 
vexes  my  mind  in  which  my  conscience  or  my 
honour  is  implicated,  or  which  would  be  even 
noticed  by  others.  If  I  could  indulge  in  religious 
duties  and  contemplations,  to  which  my  heart, 
my  judgment,  and  natural  disposition  would  lead 


OP  THE  MIND.  87 

me,  it  would,  I  really  believe,  cure  me;  but  pre- 
vious to  my  first  attack,  near  eight  years  ago,  in 
a  previous  state  of  debility  and  nervous  affection, 
which  pressed  hard  on  my  spirits.  I  wished  to 
read  on  religious  subjects,  until  all  at  once  im- 
pious and  profane  ideas  struck  my  mind;  my  soul 
recoiled,  was  shocked;  I  tried  to  banish  them; 
nothing  would  do;  not  a  moment  were  those  ideas 
absent;  at  last  they  seized  so  fast,  that  I  lost 
many  nights  and  days  sleep;  and  I  was  brought 
near  the  grave.  I  got  better,  and  overcame,  in 
some  sort,  this  immoral  influence;  but  shall  never 
be  able  to  indulge  as  I  wish  in  religious  duties. 
My  heart  often  expands  with  enthusiasm,  and  then 
I  taste  of  the  joys  of  heaven.  Now,  Sir,  can  this 
dreadful  state  of  mind  be  cured  ?  Can  I  be  made 
to  possess  less  feeling,  and  more  resolution  to 
resist  moral  influences  on  the  mind  ;  to  bear  vexa- 
tious or  distressing  incidents;  and  to  break  this 
association,  i\\\8>  fixidity  of  ideas? 

"  My  feet,  particularly  my  left  foot,  are  always 
cold ;  and  when  I  labour  under  great  anxiety, 
both  feet  have,  when  warm  in  bed,  a  sensation  as 
if  they  were  asleep  (as  we  say)  which  is  very  dis- 
tressing. My  whole  left  side  is  affected  more 
than  the  other ;  the  auditory  nerve  of  my  left  ear 
is  affected  curiously,  and  unpleasantly,  with  sharp 


88  ON  THE  DISEASES 

sounds,  as  if  the  body  touched  the  nerve ;  I  can 
not  well  describe  it. 

«If  I  could  be  tranquil,  I  should  be  well. 
Whenever  I  can  be  moved  by  ambitious  pros- 
pects or  entertain  a  desire  for  distinction,  or  any 
such  passion,  I  am  well.  This  is  sometimes  the 
case.  When  hopes  or  wishes  of  this  sort  take 
possession  of  my  mind,  they  drive  out  other  im- 
pressions; then  I  feel  well.  Active  employment, 
if  I  could  get  in  it,  would  cure  me,  but  I  know  of 
none.  When  I  feel  well,  I  am  uncommonly  cheer- 
ful, playful  and  happy. 

"  Now,  Sir,  I  beg  you,  in  consideration  of  suf- 
fering humanity,  to  take  my  case  into  your  serious 
consideration,  and  extend  to  me  the  benefit  of 
your  advice." 

In  proportion  as  the  hypochondriac  disease  ad- 
vances, the  symptoms  of  the  hysteria,  which  are 
generally  combined  with  it  in  its  first  stage,  dis- 
appear, and  all  the  symptoms  in  which  the  disease 
is  seated  acquire  a  uniformly  torpid  or  irritable 
state.  The  remissions  and  intermissions  which 
have  been  described,  cease,  and  even  the  tran- 
sient blaze  of  cheerfulness,  which  now  and  then 
escapes  from  a  heart  smothered  with  anguish, 


OF  THE  MIND.  89 

is  seen  no  more.  The  distress  now  becomes  con- 
stant. "  Clouds  return  after  every  rain."  Not  a 
ray  of  comfort  glimmers  upon  the  soul  in  any  of 
the  prospects  or  retrospects  of  life.  "  All  is  now 
darkness  without  and  within."  These  poignant 
words  were  once  uttered  by  a  patient  of  mine  with 
peculiar  emphasis,  while  labouring  under  this 
stage  of  the  disease.  Neither  nature  nor  art  now 
possess  a  single  beauty,  nor  music  or  poetry  a 
single  charm.  The  two  latter  often  give  pain 
and  sometimes  offence.  In  vain  do  love  and 
friendship,  and  domestic  affection,  offer  sympathy 
or  relief  to  the  mind  in  this  awful  situation.  Even 
the  consolations  of  religion  are  rejected,  or  heard 
with  silence  and  indifference.  Night  no  longer 
affords  a  respite  from  misery.  It  is  passed  in 
distracting  wakefulness,  or  in  dreams  more  terri- 
ble than  waking  thoughts ;  nor  does  the  light  of 
the  sun  chase  away  a  single  distressing  idea.  "  I 
rise  in  the  morning,"  says  Mr.  Cowper,  in  a  letter 
to  Mr.  Haley,  *'  like  an  infernal  frog  out  of  Ache- 
ron, covered  with  the  ooze  and  mud  of  melan- 
choly." No  change  of  place  is  wished  for  that 
promises  any  alleviation  of  suffering.  "  Could  I 
be  translated  to  paradise,"  says  the  same  elegant 
historian  of  his  own  sorrows,  in  a  letter  to  Lady 
Hesketh,  "  unless  I  could  leave  my  body  behind 
me,  my  melancholy  would  cleave  to  me  there." 

12 


90  ON  THE  DISEASES 

But  the  last  and  worst  state  of  this  form  of  de- 
rangement remains  yet  to  be  described.  After  it 
has  completely  put  off  all  its  hysterical  symptoms, 
the  patients  fly  for  relief  to  such  stimuli  as  act 
upon  the  body,  in  order  to  counteract  the  insup- 
portable pressure  of  distress  upon  their  minds. 
They  take  snuff,  or  chew  tobacco.  They  eat 
voraciously,  and  drink  wine  and  spirits  or  take 
laudanum,  in  large  quantities,  when  they  are  able 
to  procure  them.  Sometimes  the  pain  of  a 
bodily  disease  suspends  for  a  short  time  their 
mental  distress.  Mr.  Boswell,  in  his  life  of  Dr. 
Johnson,  relates  a  story  of  a  London  tradesman, 
who,  after  making  a  large  fortune,  retired  into  the 
country  to  enjoy  it.  Here  he  became  deranged 
with  hypochondriasis,  from  the  want  of  employ- 
ment. His  existence  became  finally  a  burden  to 
him.  At  length  he  was  afflicted  with  the  stone. 
In  a  severe  paroxysm  of  this  disease,  a  friend 
sympathized  with  him.  "  No,  no,"  said  he, 
"don't  pity  me,  for  what  I  now  feel  is  ease, 
compared  with  that  torture  of  mind  from  which  it 
relieves  me,"  A  woman  in  this  city  bore  a  child, 
while  she  was  afflicted  with  this  disease.  She 
declared,  immediately  afterwards,  that  she  felt  no 
more  pain  from  parturition,  than  from  a  trifling 
fit  of  the  cholic.  Where  counteracting  pains  of 
the  body  are  not  induced  by  nature  or  accident, 


OF  THE  MIND.  91 

to  relieve  anguish  of  mind,  patients  often  inflict 
them  upon  themselves.  Walking  barefooted  over 
ground  covered  with  frost  and  snow  was  resorted 
to  by  a  clergyman  of  great  worth  in  England  for 
this  purpose.  Garden,  an  eminent  physician  of 
the  fifteenth  century,  made  it  a  practice  to  bite 
his  lips,  and  one  of  his  arms,  also  to  whip  his  legs 
with  rods,  in  order  to  ease  the  distress  of  his 
mind.  Kempfer  tells  us  that  prisoners  in  Japan, 
who  often  became  partially  deranged  from  dis- 
tress, used  to  divert  their  mental  anguish  by 
burning  their  bodies  with  moxa.  The  same  de- 
gree of  pain,  and  for  the  same  purpose,  is  often 
inflicted  upon  the  body,  by  cutting  and  mangling 
it  in  parts  not  intimately  connected  with  life.  But 
bodily  pain,  whether  from  an  accidental  disease, 
or  inflicted  by  the  patients  upon  themselves,  is 
sometimes  insufficient  to  predominate  over  the 
distress  of  their  minds.  Dr.  Heberden  mentions 
an  instance  of  a  man  who  was  naturally  so  much 
afraid  of  pain,  that  he  dreaded  even  being  bled, 
who,  in  a  fit  of  low  spirits,  cut  off  his  penis  and 
scrotum  with  a  razor,  and  declared,  after  he 
recovered  the  natural  and  healthy  state  of  his 
mind,  that  he  felt  not  the  least  pain  from  that 
severe  operation.  A  similar  instance  of  insensi- 
bility to  bodily  pain  is  related  by  Dr.  Ruggieri,  an 
Italian  physician,  of  a  hypochondriac  madman  of 


92  ON  THE  DISEASES 

the  name  of  Loval,  who  fixed  himself  upon  a 
cross,  and  inflicted  the  same  wounds  upon  him- 
self, as  far  as  he  was  able,  that  had  been  inflicted 
upon  our  Saviour.  He  was  discovered  in  this 
situation  and  taken  down  alive. — During  the  pa- 
roxysms of  his  madness,  he  felt  no  pain  from 
dressing  his  wounds,  but  complained  as  soon  as 
they  were  touched  in  the  intervals  of  his  disease. 
But  this  is  not  all.  Hypochondriac  distress  seeks 
relief  in  an  evil  still  greater  than  bodily  pain. 
Can  any  thing  be  anticipated  more  dreadful  than 
universal  madness?  and  yet  I  once  attended  a 
lady  in  this  city,  whose  sufferings  from  low  spirits 
were  of  such  a  nature,  that  she  ardently  wished 
she  might  lose  her  reason,  in  order  thereby  to  be 
relieved  from  the  horror  of  her  thoughts.  This 
state  of  mind  was  not  new  in  this  disease.  Shak- 
speare  has  described  it  in  the  following  lines,  in 
his  inimitable  history  of  all  the  forms  of  derange- 
ment, in  the  tragedy  of  King  Lear.  They  are 
as  truly  philosophical,  as  they  are  poetical. 


"  Better  I  were  distract ; 


So  should  ray  thoughts  be  sever' d  from  my  griefs, 
And  woes,  by  wrong  imaginations,  lose 
The  knowledge  of  themselves." 


OP  THE  MIND.  93 

But  the  most  awful  symptom  of  this  disease 
remains  yet  to  be  mentioned,  and  that  is  DESPAIR. 
The  marks  of  the  extreme  misery  included  in 
this  word  are  sometimes  to  be  seen  in  the  coun- 
tenances and  gestures  of  hypochondriacs  in  a 
hospital ;  but  as  it  is  difficult  to  obtain  from  such 
persons  a  history  of  their  feelings,  I  shall  endea- 
vour to  give  some  idea  of  them  in  the  following 
account,  communicated  to  me  by  a  clergyman 
who  passed  four  years  and  a  half  in  this  state  of 
mind. 

He  said  "  he  felt  the  bodily  pains  and  mental 
anguish  of  the  damned;  that  he  slumbered  only, 
but  never  slept  soundly,  during  the  long  period 
that  has  been  mentioned ;  that  he  lost  his  appe- 
tites and  passions,  so  as  to  desire  and  relish 
nothing,  and  to  love  and  hate  no  one ;  that  his 
feet  were  constantly  cold,  and  the  upper  part  of 
his  body  warm  ;  that  he  lost  all  sense  of  years, 
months,  weeks,  days  and  nights,  and  even  of 
morning  and  evening;  that  in  this  respect,  time 
was  to  him  no  more."  During  the  whole  period 
of  his  misery,  he  kept  his  hands  in  constant  mo- 
tion towards  his  head  and  thighs,  and  ceased  not 
constantly  to  cry  out,  "  wretched  man  that  1  am ! 
I  am  damned ;  oh,  I  am  damned  everlastingly." 


94  ON  THE  DISEASES 

Terrible  as  the  picture  of  despair  is,  the  dis- 
ease has  symptoms  which  mark  a  still  greater  de- 
gree of  misery.  It  sometimes  creates  such  a  dis- 
gust of  life,  as  to  make  the  subjects  of  it  wish  to 
die.  How  undescribable,  and  even  incomprehen- 
sible, must  be  that  state  of  mind,  which  thus  ex- 
tinguishes the  deep  seated  principle  of  the  love  of 
life !  In  the  exquisite  tortures  of  the  stone,  and 
cholic,  and  even  under  the  progress  of  an  excru- 
ciating and  mortal  cancer  men  are  willing,  nay 
anxious,  to  live ;  of  course  the  sufferings  from 
the  anguish  of  mind  I  have  described,  exceed  the 
sufferings  from  those  diseases.  But  there  is  a 
symptom  of  despair  which  places  its  horrors 
beyond  a  mere  wish  to  die.  It  often  drives  the 
distracted  subject  of  it  to  precipitate  the  slow 
approaches  of  death  with  his  own  hand.  A  pis- 
tol, a  razor,  a  river,  a  mill-dam,  a  halter,  or  lau- 
danum, are  the  means  usually  resorted  to  for  this 
purpose.  Sometimes  the  instruments  of  death 
are  of  a  more  painful  nature.  I  have  once  seen 
the  body  of  a  Russian  officer  mangled  with  thir- 
teen wounds  inflicted  by  himself.  He  had  fallen 
into  despair  in  consequence  of  debts  contracted 
in  a  foreign  country.  Sometimes  a  horror  is 
entertained  by  persons  in  this  situation  at  the 
crime  of  suicide,  but,  in  order  to  escape  from  life, 
they  provoke  death  from  the  hands  of  govern- 


OP  THE  MIND.  95 

merit,  by  committing  murder ;  many  instances  of 
this  kind  are  to  be  met  with,  not  only  in  the 
records  of  medicine,  but  in  our  public  newspa- 
pers. Dreadful  as  this  state  of  mind  is,  there  is 
one  still  more  distressing,  and  that  is,  the  desire, 
and  fear  of  death  operating  alternately  upon  the 
mind.  I  have  seen  this  state  of  hypochondriasm. 
It  was  in  the  lady  who  wished  to  be  relieved  from 
the  horror  of  her  thoughts  by  the  complete  loss 
of  her  reason. 

After  the  history  that  has  been  given  of  the 
distress,  despair  and  voluntary  death,  which  are 
induced  by  that  partial  derangement  which  has 
been  described,  I  should  lay  down  my  pen,  and 
bedew  my  paper  with  my  tears,  did  I  not  know 
that  the  science  qf  medicine  has  furnished  a 
remedy  for  it,  and  that  hundreds  are  now  alive, 
and  happy,  who  were  once  afflicted  with  it. 
Blessed  science!  which  thus  extends  its  friendly 
empire,  not  only  over  the  evils  of  the  bodies,  but 
over  those  of  the  minds  of  the  children  of  men. 


96  ON  THE  DISEASES 


CHAPTER  IV. 


Of  the  Remedies  for  Hypochondriasis  or  Tristimania. 


THE  remedies   for  this  form  of  derangement 
divide  themselves  into  two  classes. 

I.  Such  as  are  intended  to  act  directly  upon 
the  body ;  and, 

II.  Such  as  are  intended  to  act  indirectly  upon 
the  body,  through  the  medium  of  the  mind. 

1.  Before  we  proceed  to  administer  the  reme- 
dies that  are  indicated  under  our  first  head,  it  will 
be  proper  carefully  to  review  the  history  of  all  the 
remote  and  exciting  causes  of  this  disease,  and, 
when  possible,  to  remove  them.  If  this  be  im- 
practicable, or  if  the  disease  continue  from  habit, 
after  all  its  causes  have  been  removed,  recourse 
should  be  had  to, 


OF  THE  MIND.  97 

1.  BLOODLETTING,  if  the  pulse  be  tense,  or  full; 
or  depressed,  without  either  fulness,  or  tension. 
I  have  prescribed  this  remedy  with  success,  and 
thereby  in  several  instances  suddenly  prepared 
the  way  for  its  being  cured  in  a  few  days  by  other 
medicines.  I  was  led  to  use  it  by  the  following 
fact,  communicated  to  me  by  the  late  Dr.  Thomas 
Bond.  A  preacher  among  the  Friends  called 
upon  him,  to  consult  him  in  this  state  of  mad- 
ness. He  said  he  was  possessed  of  a  devil,  and 
that  he  felt  him  constantly  in  aches  and  pains  in 
every  part  of  his  body.  The  Doctor  felt  his  pulse, 
which  he  found  to  be  full  and  tense.  He  advised 
him  to  sit  down  in  his  parlour,  and  persuaded 
him  to  let  him  open  a  vein  in  his  arm.  While 
the  blood  was  flowing  the  patient  cried  out,  "  I 
am  relieved,  I  felt  the  devil  fly  out  of  the  orifice 
in  my  vein  as  soon  as  it  was  opened."  From  this 
time  he  recovered  rapidly  from  his  derangement. 
The  advantages  of  bleeding  are  evinced  still  fur- 
ther by  the  relief  obtained  in  this  disease  by  the 
loss  of  blood  from  the  haemorrhoidal  vessels,  and 
by  other  accidental  haemorrhages.  But,  if  expe- 
rience had  not  thus  established  the  efficacy  of  this 
remedy,  its  use  would  be  suggested  by  the  habits 
of  such  patients,  of  indulging  their  appetites,  not 
only  to  satisfy  hunger,  but  to  suspend  their  dis- 

13 


98  ON  THE  DISEASES 

tress;  and  by  congestions  of  blood  in  the  liver 
and  spleen,  which  usually  takes  place  in  this  dis- 
ease. After  bleeding,  if  it  be  required. 

2.  PURGES  should  be  given.     They  are  indi- 
cated  by  the  obstructions  of  the   viscera,   and 
torpor  of  the  alimentary  canal.    They  often  bring 
away  black  bile,  and  sometimes  worms.     The 
more  active  purges,  particularly  aloes,  jalap,  and 
calomel,  should  be  preferred  in  this  disease.  The 
daughters  of  Praetus,  who  supposed  themselves  to 
be  cows,  were  cured  by  Melampus  by  means  of 
hellebore,  which  is  of  a  purging  nature.     The 
medicine  has  ever  since  borne  his  name. 

3.  EMETICS,  by  exciting  the  stomach,  often  re- 
move morbid  excitement  from  the  brain,  and  thus 
restore  the  mind  to  its  healthy  state.  They  more- 
over assist  purges  in  exciting  the  alimentary  ca- 
nal, and  in  dislodging  obstructions  from  the  ab- 
dominal viscera. 

4.  A   REDUCED  DIET,  consisting  of  food  and 
drinks  that  contain  but  little  nourishment,  should 
be  combined  with  the  three  remedies  that  have 
been  mentioned.     As  the  stomach  is  frequently  in 
a  dyspeptic  state,  the  aliment  and  drinks  should 


OP  THE  MIND.  99 

consist  of  such*  articles  as  are  least  disposed  to 
increase  or  produce  a  morbid  acid  in  it. 

After  reducing  the  action  of  the  blood-vessels, 
to  a  par  of  debility  with  the  nervous  system,  or, 
to  borrow  an  allusion  from  a  mechanical  art,  after 
plumbing  those  two  systems,  the  remedies  should 
consist, 

5.  Of  STIMULATING  ALIMEMT,  DRINKS  and  MEDI- 
CINES. 

The  diet  should  consist  of  solid  animal  food, 
with  such  vegetables  as  are  least  disposed  to 
acidity,  and  both  should  be  rendered  palatable  by 
condiments.  The  drinks  should  consist  of  old 
Madeira  or  sherry-wine,  and  porter  diluted  with 
water,  or  taken  alone,  provided  the  stomach  be 
not  affected  with  a  morbid  acid.  I  have  once 
known  this  disease  cured  by  the  liberal  use  of 
Madeira  wine.  In  some  cases,  old  claret  is  bet- 
ter received  by  the  stomach  than  the  white  wines, 
from  its  containing  less  fermentable  matter  in  it. 
The  drinks  should  be  taken  warm,  for  the  sto- 
mach is  generally  too  weak  to  react  under  the 
sedative  operation  of  such  as  are  cold.  Warm 
tea  and  coffee,  made  weak,  are  generally  grateful 
to  the  stomach,  and  should  be  advised,  when  it  is 


100  ON  THE  DISEASES 

not  affected  with  dyspepsia.  The  celebrated 
Mr.  Burke  often  relieved  the  low  spirits  which 
were  induced  by  the  solicitude  and  vexations  of 
his  political  life  by  sipping  a  tea-cup  full  of  hot 
water.  In  cases  of  dyspepsia,  or  indigestion,  as 
little  drink  as  possible  should  be  taken  with  food. 
The  medicines  proper  in  this  disease  should  be  the 
different  preparations  of  iron.  I  know  they  have 
been  said  to  be  hurtful  in  it.  It  is  true  they  are 
often  ineffectual,  but  this  is  because  the  system  is 
reduced  below  their  stimulus  in  their  ordinary 
doses.  When  given  in  large  doses,  mixed  with 
ginger,  or  black  pepper,  and  the  common  bitters 
of  the  shops,  and  persisted  in  for  several  months, 
they  are  powerful  medicines.  Tar,  in  the  form  of 
pills,  or  infused  in  water,  and  garlic  in  substance, 
or  infused  in  peppermint-tea,  afford  great  relief  in 
this  disease,  more  especially  when  the  stomach  is 
affected.  Magnesia,  lime-water  and  milk,  and  the 
alkaline  salts,  should  be  given  to  relieve  acidity 
in  the  stomach,  should  that  symptom  of  dyspepsia 
call  for  them.  Assafoetida  is  an  excellent  med- 
icine in  this  depressed  state  of  the  system,  and 
preferable  to  any  of  the  common  foatid  gums  that 
are  in  use  to  exhilarate  the  spirits.  But  our  prin- 
cipal reliance  for  that  purpose  should  be  upon 
opium.  Mr.  Cowper  says,  ten  drops  of  laudanum, 
taken  occasionally,  saved  him  from  being  "  de- 


OP  THE  MIND.  101 

voured  by  melancholy."  This  noble  medicine, 
which  has  been  happily  called  "  the  medicine  of 
the  mind,"  has  many  advantages  over  ardent 
spirits  as  a  cordial.  It  affords  more  prompt 
relief;  a  habit  of  attachment  to  it  is  more  slowly 
formed,  and  more  easily  broken.  It  does  not  pol- 
lute the  breath,  nor  does  it  ever  tend  to  excite,  or 
increase  that  hysterical  irritability  of  temper 
which  is  sometimes  connected  with  this  disease. 
However  useful  ardent  spirits  may  be  in  transient 
diseases,  they  can  not  be  used  in  such  as  are  of  a 
chronic  nature  without  inducing  such  a  fondness 
for  them  as  not  only  to  prevent  their  acting  as 
remedies,  but  to  convert  them  into  poisons,  often 
alike  fatal  to  the  soul  and  body. 

6.  The  WARM  BATH,  applied  in  the  form  of 
water,  or  vapour,  and  rendered  more  stimulating, 
if  necessary,  by  the  addition  of  saline  or  aromatic 
substances  to  it.     The  heat  of  the  water  should 
be  a  little  above  that  of  the  body.     It  does  most 
service  when  it  induces  sweats.     Mr.   Cowper 
was  always  relieved  by  that  discharge  from  his 
skin. 

7.  The  COLD  BATH.     This  remedy  should   not 
be  advised  until  the  system  has  been  prepared  for 
it  by  the  previous  use  of  the  warm  bath. 


102 


ON  THE  DISEASES 


8.  FRICTIONS   to  the  trunk  of  the  body  and 
limbs.    These  tend  very  much  to  excite  the  cuta- 
neous extremities  of  the  nerves  and  blood-vessels, 
and  thus  to  equalize  the  excitement  of  the  sys- 
tem.    I  have  known  two  instances  in  which  a  re- 
covery from  this  disease  succeeded  an  attack  of 
the  itch.— The  remedy  to  this  case  was  probably 
the  pleasurable  sensation  exhibited  by  scratch- 
ing, in  order  to  relieve  it. 

9.  EXERCISE,  especially  upon  horseback.     La- 
bour is  still  more  useful,  particularly  in  the  open 
air. 

10.  The  excitement  of  PAIN.     I  mentioned  the 
accidental  effects  of  the  pain  of  a  stone  in  the 
bladder,  and  of  burning  moxa  on  the  body,  in  sus- 
pending anguish  of  mind  in  the  history  of  this  dis- 
ease.    It  may  be  excited  in  various  ways.     Mus- 
tard to  the  feet  is  generally  sufficient  for  this 
purpose.     I   once   attended    a   gentleman    from 
Barbadoes,  who  suffered  great  distress  of  mind 
from  a  hypochondriac  gout  which  floated  in  his 
nerves  and  brain;  but  no  sooner  did  the  gout  fix 
and  excite  pain  in  his  hands  or  feet,  than  he  re- 
covered his   spirits,  and   became   pleasant   and 
agreeable  to  all  around  him. 


OP  THE  MIND.  103 

11.  SALIVATION.      Mercury  acts  in  this  dis- 
ease, 1,  by  abstracting  morbid  excitement  from 
the  brain  to  the  mouth.     2,  By  removing  visceral 
obstructions.     And  3,  by  changing  the  cause  of 
our  patient's  complaints,  and  fixing  them  wholly 
upon   his  sore  mouth.     The  salivation  will  do 
still   more   service  if  it  excite   some    degree  of 

O 

resentment  against  the  patient's  physician  or 
friends.  The  effects  of  mercury  in  this  disease, 
have  sometimes  been  compared  to  those  of  a 
handful  of  shot  shaken  in  a  bottle,  lined  with  filth 
and  dirt,  in  order  to  clean  it.  It  stimulates  every 
part  of  the  body,  renders  the  vessels  pervious  to 
their  natural  juices,  conveys  morbid  action  out  of 
the  body  by  the  mouth,  and  thus  restores  the 
mind  to  its  native  seat  in  the  brain. 

12.  BLISTERS  and  ISSUES  have  been  found  useful 
in  this  form  of  madness.     They  are  calculated  to 
excite  the  action  of  the  skin,  and  to  produce  what 
has  been  happily  called  a  centrifugal  direction  of 
the  fluids.     They  are  more  particularly  indicated, 
if  the  disease  have  been  induced  by  eruptions  re- 
pelled from  the  skin. 

II.  We   come   next   in   order  to   mention  the 
remedies   for  the  body,  which  are  intended  to 


104  ON  THE  DISEASES 

act  through  the  medium  of  the  mind.  The 
first  thing  to  be  done  by  a  physician,  under  this 
head,  is  to  treat  the  disease  in  a  serious  manner. 
To  consider  it  in  any  other  light,  is  to  renounce 
all  observation  in  medicine.  However  erroneous 
a  patient's  opinion  of  his  case  may  be,  his  dis- 
ease is  a  real  one.  It  will  be  necessary,  therefore, 
for  a  physician  to  listen  with  attention  to  his  tedi- 
ous and  uninteresting  details  of  its  symptoms  and 
causes.  In  some  cases,  patients  wish  to  think 
their  diseases  are  trifling,  and  attended  with  no 
danger,  but  in  hypochondriasis  they  are  always 
best  satisfied  in  believing  their  disease  to  be  diffi- 
cult and  dangerous.  A  physician  should  carefully 
avoid  likewise  speaking  lightly  of  his  patient's 
disease  to  his  friends  and  neighbours,  for  he 
will  take  uncommon  pains  to  discover,  from 
them,  his  opinion  of  his  case,  and  if  it  be  differ- 
ent from  that  which  has  been  given  to  him,  he 
will  not  only  reproach  him  with  a  want  of  can- 
dour, but  will  immediately  seek  relief  from  ano- 
ther physician.  I  once  knew  an  instance  of  this 
kind  in  this  city.  The  patient  refused  to  see  the 
physician  afterwards,  who  had  thus  deceived  him. 
In  the  worst  grade  of  this  disease,  he  will  not 
bear  contradiction,  and  hence  it  will  be  neces- 
sary to  conform  our  remedies  as  much  as  possi- 


OP  THE  MIND.  105 

ble  to  his  erroneous  opinions  of  the  nature  of  his 
disease.  If  he  believes  himself  to  be  affected 
with  any  of  the  diseases  that  were  formerly 
named,  medicines  must  be  prescribed  for  them, 
and  administered  in  a  manner  calculated  to  act 
upon  his  principle  of  faith,  and  to  beget  his  con- 
fidence in  them.  In  the  more  moderate  grade  of 
his  errors  upon  the  subject  of  his  disease,  contra- 
diction and  reasoning  may  be  opposed  to  them. 
When  these  means  are  employed,  the  conduct 
of  a  physician  should  correspond  with  them.  I 
once  injured  myself,  and  my  patient,  who  sup- 
posed himself  to  be  affected  with  the  venereal 
disease,  by  prescribing  for  him  a  few  mercurial 
pills,  in  compliance  with  his  earnest  solicitations, 
after  having  assured  him  that  he  had  not  a  parti- 
cle of  its  virus  in  his  system.  I  have  in  several 
instances  removed  all  doubt  upon  the  subject,  by 
advising  matrimony,  or  a  renewal  of  conjugal  in- 
tercourse, if  my  patients  were  married,  and  by 
offering  them  at  the  same  time  a  bond  for  a  large 
sum  of  money,  if  any  bad  consequences  should 
follow  their  obedience  to  my  advice.  In  this  way 
I  have  made  many  gentlemen  happy,  and  never 
in  a  single  instance  incurred  the  least  discredit  or 
blame. 

14 


106  ON  THE  DISEASES 

Persons  afflicted  with  this  form  of  derange- 
ment, I  said  formerly,  now  and  then  believe  them- 
selves to  be  poisoned.  In  this  case  it  is  some- 
times necessary  to  humour  their  error,  and  to 
prescribe  suitable  means  to  remove  it.  Dr.  Cox, 
in  his  Treatise  upon  Insanity,  has  furnished  us 
with  an  excellent  precedent  for  this  purpose.  A 
gentleman  in  England  supposed  a  shirt  which  he 
had  worn,  had  been  poisoned  by  his  maid,  and 
determined  to  subject  her  to  the  punishment  of 
the  law.  His  physician  humoured  his  belief  and 
resentment,  by  pretending  to  have  discovered  a 
poisonous  matter  in  his  shirt,  by  means  of  some 
chymical  experiments  upon  it,  and  concurred  with 
him  in  prosecuting  his  maid  for  an  intended  mur- 
der. A  new  course  was  hereby  given  to  his 
thoughts,  and  a  new  action  excited  in  his  brain, 
by  which  he  was  perfectly  cured. 

Terror  once  cured,  for  a  while,  a  patient  of  mine, 
of  a  belief  that  he  had  been  poisoned  by  taking 
arsenic  as  a  medicine,  and  that  it  had  eaten  out 
his  bowels.  A  student  of  medicine,  to  whom  he 
told  his  tale,  attempted  to  convince  him  of  his 
error,  upon  which  he  begged  him  to  open  him, 
and  to  satisfy  himself  by  examining  the  cavity  of 
his  belly.  After  some  preparation,  the  student 
laid  him  upon  a  table,  and  drew  the  back  of  a  knife 


OF  THE  MIND.  107 

from  one  extremity  of  his  belly  to  the  other. 
"  Stop,  stop."  said  my  patient,  "  I've  got  guts," 
and  suddenly  escaped  from  the  hands  of  his  ope- 
rator. His  cure  would  probably  have  been  dura- 
ble, after  the  use  of  this  remedy,  had  not  real  dis- 
tress, from  another  cause,  brought  back  that 
which  was  imaginary. 

If  our  patient  imagine  he  has  a  living  animal  in 
his  body,  and  he  can  not  be  reasoned  out  of  a  be- 
lief of  it,  medicines  must  be  given  to  destroy  it; 
and  if  an  animal,  such  as  he  supposes  to  be  in  his 
body,  should  be  secretly  conveyed  into  his  close 
stool,  the  deception  would  be  a  justifiable  one,  if 
it  served  to  cure  him  of  his  disease. 

If  our  patient  should  believe  himself  to  be 
transformed  into  an  animal  of  another  species  by 
transmigration,  or  in  any  other  way,  our  remedies 
should  be  accommodated  to  the  grade  of  his  mad- 
ness, and  the  nature  of  the  animal  into  which  he 
supposes  himself  to  be  changed.  Ridicule  has 
sometimes  been  employed  with  success  in  such 
cases.  Mr.  Pinel  mentions  an  instance  of  its  sud- 
den efficacy  in  curing  a  watchmaker  in  Paris, 
who  believed  that  his  head  had  been  cut  off,  and 
that  he  carried  the  head  of  a  man  who  had  been 
guillotined  instead  of  his  own. 


108  ON  THE  DISEASES 

A  physician,  formerly  of  this  city,  used  to  di- 
vert his  friends,  by  relating  the  history  of  a  cure 
which  had  been  performed  of  a  patient  in  this 
form  of  madness,  who  believed  himself  to  be  a 
plant.  One  of  his  companions,  who  favoured  his 
delusion,  persuaded  him  he  could  not  thrive  with- 
out being  watered,  and  while  he  made  the  patient 
believe,  for  some  time,  he  was  pouring  water 
from  the  spout  of  a  tea-pot,  discharged  his  urine 
upon  his  head.  The  remedy  in  this  case  was 
resentment  and  mortification. 

Cures  of  patients,  who  suppose  themselves  to 
be  glass,  may  easily  be  performed  by  pulling  a 
chair,  upon  which  they  are  about  to  sit,  from  un- 
der them,  and  afterwards  showing  them  a  large 
collection  of  pieces  of  glass  as  the  fragments  of 
their  bodies. 

An  unwillingness  to  discharge  the  contents  of 
the  bladder,  from  the  cause  that  has  been  men- 
tioned, was  once  cured  by  persuading  the  patient 
that  the  world  was  on  fire,  and  that  nothing  but 
his  water  would  extinguish  it.  This  error  was 
cured  by  Dr.  Ferriar  by  means  of  an  emetic, 
which  by  its  action  upon  the  stomach,  destroyed 
the  command  of  the  patient's  will  over  the  sphinc- 
ter of  the  bladder. 


OF  THE  MIND.  109 

I  have  heard  of  a  person  afflicted  with  this  dis- 
ease, who  supposed  himself  to  be  dead,  who  was 
instantly  cured  by  a  physician  proposing  to  his 
friends,  in  his  hearing,  to  open  his  body,  in  order 
to  discover  the  cause  of  his  death. 

In  all  the  cases  that  have  been  mentioned,  of 
error  and  distress  which  relate  to  the  body  only, 
similar  advantages  would  probably  arise  from  ex- 
citing fear  or  anger,  or  any  other  powerful  emo- 
tion of  the  mind. 

I  attended  a  young  man  in  the  year  1806,  who 
cherished  an  obstinate  hypochondriac  belief,  after 
his  recovery  from  the  autumnal  fever,  that  he 
should  die,  and  felt  at  the  same  time  a  great  dread 
of  death.  I  assured  him  over  and  over  that  he 
was  in  no  danger,  but  without  being  able  to 
inspire  him  with  the  least  expectation  of  life.  In 
one  of  my  visits  to  him,  I  asked  him  upon  enter- 
ing his  room,  how  he  was;  "very  bad,"  said  he, 
and  repeated  his  belief  that  he  should  soon  die. — 
His  nurse,  who  sat  by  him,  added,  that  he  had 
fixed  upon  an  hour  in  the  approaching  night  as 
the  time  for  his  dissolution.  After  pausing  a  few 
moments,  I  asked  him  if  I  should  send  a  joiner  to 
measure  him  for  his  coffin.  This  question  in- 
stantly gave  a  new  current  to  his  feelings,  and 


110  ON  THE  DISEASES 

from  that  time  he  recovered  rapidly,  nor  did  he 
ever  mention  an  apprehension  of  dying  to  me,  in 
any  of  my  subsequent  visits  to  him.  Anger  had 
uniformly  the  same  beneficial  effects  upon  a  gen- 
tleman in  Maryland,  who,  when  in  health,  was 
accustomed  to  speculate  upon  controverted  sub- 
jects in  religion.  There  was  an  opinion  held  by 
one  sect  of  Christians,  which  he  held  in  great  ab- 
horrence. His  friends,  who  knew  this,  always 
contrived,  when  they  saw  him  unusually  dejected, 
to  provoke  a  controversy  with  him  upon  the  sub- 
ject that  wa-s  hateful  to  him.  It  never  failed  to 
rouse  his  resentment,  and  thereby  to  banish,  for  a 
while,  a  paroxym  of  his  disease. 

If  debt  be  the  cause  of  our  patient's  disease,  we 
may  presume  it  has  been  incurred  with  a  clear 
conscience,  and  a  fair  character,  for  a  dishonest 
man  seldom  feels  distress  enough  from  this  cause 
to  bring  on  disease.  In  this  case  we  must  advise 
our  patient  to  take  the  benefit  of  our  insolvent 
and  bankrupt  laws.  Many  men  have  been  thus 
saved  from  a  miserable  death,  and  restored  to 
health,  and  usefulness  to  their  families  and  so- 
ciety. 

If  the  disease  has  been  induced  by  the  suppos- 
ed or  real  ingratitude,  neglect,  or  ill  usage  of 


* 

OP  THE  MIND.  Ill 

friends  or  relations,  there  are  two  modes  of  treat- 
ing it;  one  consists  in  advising  forgiveness,  or 
contempt  of  the  injury;  the  other,  in  exciting  a 
moderate  degree  of  anger  against  the  persons 
who  have  offended  or  injured  our  patients.  This 
anger,  by  its  stimulus,  counteracts  the  depression 
both  of  the  body  and  mind.  It  should  be  carefully 
guarded  from  venting  itself  in  acts  of  malice  or 
revenge. 

If  the  disease  be  induced  by  nostalgia,  or  what 
is  called  home-sickness,  the  patient  should  be  ad- 
vised to  visit  his  native  country.  It  was  once 
cured  by  this  means  in  a  Welch  soldier  in  the 
British  army.  When  this  remedy  can  not  be  em- 
ployed, it  should  be  opposed  by  exciting  a  pow- 
erful or  active  counter  passion.  In  the  year  1733, 
General  Praxin  led  a  Russian  army  to  the  banks 
of  the  Rhine.  At  this  remote  distance  from  their 
native  country,  five  or  six  soldiers  became  unfit 
for  duty  every  day  from  home-sickness.  The 
General  issued  an  order  to  bury  alive  all  who 
were  affected  with  it.  This  punishment  was  in- 
flicted in  two  or  three  instances,  in  consequence 
of  which  the  disease  instantly  disappeared  from 
the  army.  Fear,  excited  by  a  far  less  cruel 
remedy,  I  have  no  doubt,  would  have  had  the 
same  effect. 


112  ON  THE  DISEASES 

The  remedies  for  this  disease,  when  brought 
on  by  disappointed  love,  and  by  grief,  shall  be 
mentioned,  when  we  come  to  treat  of  the  cure  of 
the  diseases  of  the  passions. 

It  will  naturally  occur  to  the  reader  that  the 
three  last  causes  of  hypochondriac  madness  will 
be  concealed  by  a  patient  from  the  knowledge  of 
a  physician.  But  they  must  be  extorted,  by  direct 
or  indirect  means,  or  the  appropriate  remedies 
can  not  be  employed  to  remove  their  hurtful  in- 
fluence upon  the  system. 

If  the  derangement  of  our  patient  has  been  in- 
duced by  the  real  or  supposed  distresses  of  his 
country,  it  will  be  proper  to  advise  him  to  avoid 
reading  newspapers,  and  conversing  upon  politi- 
cal subjects,  and  thereby  to  acquire  a  total  igno- 
rance of  public  events.  But  if  he  object  to  this 
remedy,  he  should  be  advised  to  take  a  part  in 
the  disputes  which  divide  his  fellow-citizens.  In 
favour  of  this  conduct,  I  shall  mention  a  single 
fact.  There  was  a  form  of  this  disease,  well 
known,  during  the  revolutionary  war,  in  several  of 
the  States,  by  the  names  of  the  tory-rot,  and  the 
protection-fever.  It  was  confined  exclusively  to 
those  friends  of  Great  Britain,  and  to  those  timid 
Americans  who  took  no  public  part  in  the  war. 


OF  THE  MIND,  1 1  3 

Many  of  them  died  of  it,  but  not  a  single  whig 
nor  royalist,  who  took  an  active  part  in  the  revo- 
lution, was  affected  with  it.  This  was  the  more 
remarkable,  as  many  of  them  lost  their  fortunes 
and  former  rank  in  society,  by  their  exertions  in 
support  of  the  principles  and  measures  to  which 
they  had  devoted  their  passions  or  their  lives.  By 
eating  garlic,  we  become  insensible  of  the  breath 
of  persons  that  have  been  rendered  offensive  by  it. 
In  like  manner,  by  imbibing  a  portion  of  party 
spirit,  we  become  insensible  of  the  vices  and  fol- 
lies of  our  associates  in  politics,  and  thus  diminish 
more  or  less  than  one  half  (according  to  the  num- 
ber of  our  party)  this  source  of  hypochondriacal 
derangement.  Happily  for  our  citizens,  the  dis- 
ease that  has  been  named  has  passed  away  with 
the  events  of  the  American  revolution,  and  from 
the  general  operation  of  the  above  remedies,  as 
well  as  from  causes  formerly  mentioned,  it  has 
rarely  been  succeeded  by  any  other  form  of  po- 
litical hypochondriasm  in  the  United  States. 

If  the  disease  be  derived  from  a  sense  of  guilt, 
it  is  generally  connected  with  ignorance  or  erro- 
neous opinions  in  religion.  The  former  must  be 
removed,  by  advising  the  visits  of  a  sensible  and 
enlightened  clergyman.  The  latter  consist,  gene- 
rally, in  our  patient's  believing  one  or  both  the 


ON  THE  DISEASES 


following  errors  :  1  .  That  he  is  excluded  from  the 
divine  mercy  by  an  irreversible  decree  of  the  Su- 
preme Being;  or,  in  other  words,  that  he  was 
created  on  purpose  to  be   made   miserable  for 
ever.  —  The  second  error  believed  by  our  patient 
is,  that  he  has  committed  the  unpardonable  sin. 
To  the  first  error  we  may  reply,  that  there  is  no 
pagan  opinion  more  contrary  to  nature  and  rea- 
son, and  to  the  whole  tenor,  as  well  as  to  the 
most  consistent  interpretations  of  the  Scriptures, 
than  the  doctrine  of  men  being  called  into  exist- 
ence on  purpose  to  endure  the  pains  of  eternal 
misery.     To  the  second  error  we  may  reply,  that 
no  two  divines  agree  in  what  constitutes  the  un- 
pardonable sin;  that  many  wise  and  good  men 
believe  it  is  not  possible  to  commit  it,  in  the  pre- 
sent state  of  the  gospel  dispensation,  and  all  di- 
vines agree  that  "  no  man  had  committed  it,  who 
was  afraid  he  had."     It  is  of  consequence  to  a 
physician,  to  be  fully  prepared  upon  the  subjects 
of  the  two  errors  that  I  have  named,  for  they  are 
the  two  principal  causes  of  religious  hypochon- 
driasm. 

In  the  application  of  all  these  remedies  to  the 
mind,  it  is  of  consequence  to  know  that  there  are 
acquiescing,  reasoning,  contradicting  and  ridi- 
culing points  in  this  disease,  above  which  they 


OF  THE  MIND.  115 

respectively  do  harm,  and  below  which  they  are  of 
no  efficacy. 

In  all  cases  it  will  be  proper  to  seduce  patients 
from  conversing  upon  their  disease.  "  Conversa- 
tion upon  melancholy,"  says  Dr.  Johnson,  «  feeds 
it;"  for  which  reason  he  advises  his  friend  Bos- 
well,  who  was  subject  to  it,  "  never  to  speak  of 
it,  to  his  friends,  nor  in  company." 

There  are  several  other  remedies  which  act 
upon  the  body  through  the  medium  of  the  mind, 
and  that  are  proper,  in  this  disease,  from  all  its 
causes.  The  first  of  these  is,  the  DESTRUCTION  of 
all  old  associations  of  ideas.  Every  thing  a  hypo- 
chondriac patient  sees  or  hears,  becomes  tinc- 
tured with  some  sad  idea  of  his  disease.  Hence 
the  same  objects  and  sounds  never  fail  of  renew- 
ing the  remembrance  of  it.  Change  therefore  his 
dress,  his  room,  his  habitation,  and  his  company, 
as  often  as  possible.  A  gentleman  of  South  Car- 
olina used  to  cure  himself  of  a  fit  of  low  spirits  by 
changing  his  clothes.  Even  change  his  person 
as  much  as  possible.  Long  nails,  a  long  beard, 
and  uncombed  hair,  often  become  exciting  causes 
of  a  paroxysm  of  this  disease.  They  should  there- 
fore be  carefully  prevented  or  removed. 


116  ON  THE  DISEASES 

2.  EMPLOYMENT,  or  business  of  some  kind.  Man 
was  made  to  be  active.  Even  in  paradise  he  was 
employed  in  the  healthy  and  pleasant  exercises  or 
cultivating  a  garden.  Happiness,  consisting  in 
folded  arms,  and  in  pensive  contemplation,  be- 
neath rural  shades,  and  by  the  side  of  purling 
brooks,  never  had  any  existence,  except  in  the 
brains  of  mad  poets,  and  love-sick  girls  and  boys. 
Hypochondriac  derangement  has  always  kept 
pace  with  the  inactivity  of  body  and  mind  which 
follows  wealth  and  independence  in  all  countries. 
It  is  frequently  induced  by  this  cause  in  those 
citizens,  who  retire,  after  a  busy  life,  into  the 
country,  without  carrying  with  them  a  relish  for 
agriculture,  gardening,  books,  or  literary  society. 

Building,  commerce,  a  public  employment,  an 
executorship  to  a  will;  above  all,  agriculture, 
have  often  cured  this  disease.  The  last,  that  is, 
agriculture,  by  agitating  the  passions  by  alternate 
hope,  fear  and  enjoyment,  and  by  rendering  bodily 
exercise  or  labour  necessary,  is  calculated  to  pro- 
duce the  greatest  benefit.  Great  care  should, 
however,  be  taken,  never  to  advise  retirement  to 
a  part  of  the  country  where  good  society  can  not 
be  enjoyed  upon  easy  terms. 

In  those  cases  in  which  the  body  can  not  be 


OP  THE  MIND.  117 

employed,  the  mind  should  be  kept  constantly 
busy. — Mr.  Cowper  often  relieved  his  melancholy 
by  reading  novels.  Hence  he  has  well  said, 

"  Absence  of  occupation  is  not  rest, 

A  mind  quite  vacant  is  a  mind  distressed." 

I  knew  a  lady  in  whom  this  disease  was  brought 
on  by  a  disappointment  in  love,  who  cured  herself 
by  translating  Telemachus  into  English  verse. 
The  remedy  here  was,  chiefly,  constant  employ- 
ment. 

Dr.  Burton,  in  his  Anatomy  of  Melancholy,  de- 
livers the  following  direction  for  its  cure :  "  Be 
not  idle ;  be  not  solitary."  Dr.  Johnson  has  im- 
proved this  advice  by  the  following  commentary 
upon  it.  "  When  you  are  idle,  be  not  solitary ; 
and  when  you  are  solitary,  be  not  idle."  The 
illustrious  Spinola,  upon  hearing  of  the  death  of  a 
friend,  inquired  of  what  disease  he  died  ?  "  Of 
having  nothing  to  do,"  said  the  person  who  men- 
tioned it.  "Enough"  said  Spinola,  "to  kill  a 
general."  Not  only  the  want  of  employment,  but 
the  want  of  care,  often  increases,  as  well  as 
brings  on  this  disease.  This  was  exemplified  in 
the  two  instances,  formerly  mentioned,  of  suicide 
being  induced  by  situations  in  which  the  heart 
wished  and  cared  for  nothing. 


118  ON  THE  DISEASES 

Concerts,  evening  parties,  and  the  society  of 
the  ladies,  to  gentlemen  affected  with  this  disease, 
have  been  useful.  Of  the  efficacy  of  the  last,  Mr. 
Green  has  happily  said, 

"  With  speech  so  sweet,  so  sweet  a  mien, 
They  excommunicate  the  spleen." 

3.  CERTAIN  AMUSEMENTS.  Those  should  be  pre- 
ferred, which,  while  they  interest  the  mind,  afford 
exercise  to  the  body.  The  chase,  shooting,  play- 
ing at  quoits,  are  all  useful  for  this  purpose.  The 
words  of  the  poet,  Mr.  Green,  upon  this  subject, 
deserve  to  be  committed  to  memory  by  all  physi- 
cians. 

"  To  cure  the  mind's  wrong  bias,  spleen, 
Some  recommend  the  bowling-green ; 
Some  hilly  walks — all  exercise, 
Fling  but  a  stone — the  giant  dies." 

Chess,  checkers,  cards  and  even  push-pin, 
should  be  preferred  to  idleness,  when  the  weather 
forbids  exercise  in  the  open  air.  The  theatre  has 
often  been  resorted  to,  to  remove  fits  of  low  spi- 
rits :  and  it  is  a  singular  fact,  that  a  tragedy  oftener 
dissipates  them  than  a  comedy.  The  remedy, 
though  distressing  to  persons  with  healthy  minds, 
is  like  the  temperature  of  cold  water  to  persons 


OP  THE  MIND.  1 19 

benumbed  with  frost;  it  is  exactly  proportioned 
to  the  excitability  of  their  minds,  and  it  not  only 
abstracts  their  attention  from  themselves,  but 
even  revives  their  spirits. 

A  female  patient  of  mine,  in  whom  this  disease 
had  several  times  been  excited  by  family  afflic- 
tions, lost  a  favourite  child  in  November  1811, 
which  produced  many  of  its  symptoms.  Soon 
afterwards  her  husband  became  sick.  The  lighter 
and  dissimilar  distress  occasioned  by  this  event, 
suddenly  removed  her  disease,  and  she  regained, 
with  the  recovery  of  her  husband,  her  usual  health 
and  spirits.  Mirth,  or  even  cheerfulness,  when 
employed  as  remedies  in  low  spirits,  are  like  hot 
water  to  a  frozen  limb.  They  are  dispropor- 
tioned  to  the  excitability  of  the  mind,  and,  instead 
of  elevating,  never  fail  to  increase  its  depression 
or  to  irritate  it.  Mr.  Cowper  could  not  bear  to 
hear  his  humorous  story  of  John  Gilpin  read  to 
him  in  his  paroxysms  of  this  disease.  It  was  to 
his  "  heavy  heart,"  what  Solomon  happily  com- 
pares to  the  conflict  produced  by  pouring  vinegar 
upon  nitre,  or  in  other  words,  upon  an  alkaline 
salt. 

Certain  objects,  distinguished  for  their  beauty 
or  grandeur,  often  afford  relief  in  this  disease. 
Mr.  Cowper  experienced  a  transient  elevation  of 


120  ON  THE  DISEASES 

spirits,  from  contemplating  the  ocean  from  the 
house  of  his  friend,  Mr.  Haley ;  and  the  unfortu- 
nate Mrs.  Robinson  soothed  the  gloom  of  her 
mind,  by  viewing  the  dashing  of  the  waves  of  the 
same  sublime  object,  by  the  light  of  the  moon  at 
Brighton.  Certain  animals  suspend  the  anguish 
of  mind  of  this  disease  by  their  innocence,  inge- 
nuity, or  sports.  Mr.  Cowper,  sometimes,  found 
relief  in  playing  with  three  tame  hares,  and  in  ob- 
serving a  number  of  leeches  to  rise  and  fall  in  a 
glass  with  the  changes  in  the  weather.  The  poet 
says,' 

"  Laugh  and  be  wdl.     Monkeys  have  been 
Extreme  good  doctors  for  the  spleen. 
And  kitten — if  the  humour  hit, 
Has  harlequin'd  away  the  fit." 

The  famous  Luther  was  cheered  under  his  fits 
of  low  spirits  by  listening  to  the  prattle,  and  ob- 
serving the  sports  and  innocent  countenances  of 
young  children.  The  tone  of  their  voices  is  proba- 
bly a  source  of  a  part  of  the  relief  derived  from 
their  company.  Mr.  Cowper  was  always  exhila- 
rated by  conversing  with  Mr.  Haley's  son,  only 
because  he  was  pleased  with  the  soft  arid  musical 
tones  of  his  voice. 

4.  Music  has  often  afforded  great  relief  in  this 
disease.  Luther,  who  was  sorely  afflicted  with  it, 


OF  THE  MIND.  121 

has  left  the  following  testimony  in  its  favour. 
"  Next  to  theology,  I  give  the  highest  place  to 
music,  for  thereby  all  anger  is  forgotten;  the 
devil,  also  melancholy,  and  many  tribulations  and 
evil  thoughts  are  driven  away."  For  the  same 
reason  that  tragedies  afford  more  relief  than 
comedies,  plaintive  tunes  are  more  useful  than 
such  as  are  of  a  sprightly  nature.  I  attended  a 
citizen  of  Philadelphia,  occasionally,  in  paroxysms 
of  this  disease,  who  informed  me  that  he  was 
cured  of  one  of  them  by  hearing  the  Old  Hundred 
psalm  tune  sung  in  a  country  church.  His  dis- 
ease, he  said,  instantly  went  off  in  a  stream  of 
tears.  Dr.  Cardan  always  felt  a  suspension  of 
the  anguish  of  his  mind  from  the  same  cause;  and 
Mr.  Cowper  tells  his  friend,  Mr.  Haley,  in  one  of 
his  letters,  that  he  was  "  relieved  as  soon  as  his 
troubles  gushed  from  his  eyes."  The  tears  in 
these  cases  acted  by  indirectly  depleting  from  the 
brain. 

It  is  remarkable,  that  sprightly  tunes  are  as 
offensive  as  comic  representations  in  this  disease. 
This  was  once  exemplified  by  a  Mr.  Derberow, 
formerly  a  patient  in  the  Pennsylvania  Hospital. 
In  a  fit  of  low  spirits,  he  heard  the  sound  of  a 
lively  tune  from  a  flute  in  an  adjoining  room.  He 
suddenly  rushed  into  it,  snatched  the  flute  from 

16 


122  ON  THE  DISEASES 

the  gentleman's  hands  who  was  playing  upon  it, 
and  broke  it  in  pieces  upon  his  head. 

5.  Committing  entertaining  passages  of  prose 
and  verse  to  MEMORY,  and  copying  manuscripts, 
have  been  found  useful   in  relieving  hypochon- 
driasm.     They  divert  and  translate  attention  and 
action  from  the  understanding  to  a  sound  part  of 
the  mind.     Reading  aloud  has  nearly  the  same 
effect. 

6.  Dr.     Burton    recommends,   in  the   highest 
terms,  the  reading  of  the  BIBLE  to  hypochondriac 
patients.     He   compares  it  to  an   apothecary's 
shop,  in  which  is  contained  remedies  for  every 
disease  of  the  body.     I  have  frequently  observed 
the  langour  and  depression  of  mind  which  occur 
in  the  evening  of  life,  to  be  much  relieved  by  the 
variety  of  incidents,  and  the  sublime  and  com- 
fortable passages,  that  are  contained  in  that  only 
true  history  of  the  origin,  nature,  duties  and  future 
destiny  of  man.  A  captain  Woodward,  of  Boston, 
who  lately  suffered  all  the  hardships  of  shipwreck 
on  an  inhospitable  island  in  the  East  Indies,  found 
great  comfort  in  revolving  the  history  of  Joseph 
and  his  brethren  in  his  mind.     A  captain  Ingle- 
field  revived  his  spirits,  and  those  of  his  crew,  in 
a    similar    situation,    by    telling   them   pleasant 
stories. 


OF  THE  MIND.  123 

The  mind  requires  a  succession  of  connected 
events  to  divert  it  from  itself,  and  this  is  the  rea- 
son why  stories  of  all  kinds,  which  require  con- 
stant attention  to  comprehend  them,  are  so  useful 
in  this  disease. 

Where  there  is  no  relish  for  the  simple  and 
interesting  stories  contained  in  the  Bible,  the 
reading  of  novels  should  be  recommended  to  our 
patients.  They  contain  a  series  of  supposed 
events  which  arrest  the  attention,  and  cause  the 
mind  to  forget  itself.  It  is  because  they  so  uni- 
formly produce  this  effect  that  they  are  often  re- 
sorted to  by  old  people  even  of  elevated  under- 
standings, in  order  to  divert  themselves  from  the 
depression  of  spirits  which  the  death  or  treachery 
of  friends,  bodily  pain,  and  the  dread  of  futurity, 
create  in  their  minds. 

7.  MENTIONING  the  NAME  of  a  parent,  relation, 
or  friend,  from  whom  the  patient  has  received 
acts  of  kindness,  protection  or  relief,  in  early  life. 
We  fly  from  habit  to  those  persons,  when  in  dis- 
tress in  any  part  of  our  lives,  who  have  succoured 
us  under  the  pains  and  distresses  of  childhood. 
These  persons  are  generally  our  parents.  I  once 
assisted  in  performing  the  operation  of  lithotomy 
upon  a  young  gentleman  in  this  city,  whose  only 


124  ON  THE  DISEASES 

cry  during  the  operation  was,  "  O  !  my  father,  my 
father !"  I  have  heard  a  woman  utter  the  name 
of  her  mother  only,  during  the  whole  time  of  the 
excision  of  a  cancerous  breast.  I  attended  a 
young  gentleman  in  our  Hospital,  in  the  year 
1803,  in  this  disease,  who  had  lived  with  a  most 
indulgent  grandfather  when  a  boy.  In  the  lowest 
stage  of  his  depression,  the  mentioning  the  name 
only,  of  his  grandfather,  revived  him,  and  often 
drew  him  into  pleasant  conversation.  The  same 
advantages  might  probably  be  derived,  from  car- 
rying a  patient's  memory  and  imagination  back 
to  the  innocent  and  delightful  sports  and  studies 
of  early  life. 

8.  MATRIMONY,  if  our  patients  are  single.     The 
constant  pursuits   and  wholesome    cares    of  a 
family  generally  prevent  and  cure  'such  as  are 
transient  and  imaginary. 

9.  TERROR,  by  the  concussion  it  gives  to  both 
body  and  mind,  has  sometimes  cured  this  disease. 
A  lady  in  New  York,  in  whom  it  was  induced  by 
the  habitual  use  of  opium,  was   cured   by  this 
remedy,  administered  by  the  hand  of  her  physi- 
cian.    In  one  of  his  visits  to  her,  he  took  a  large 
snuff-box  out  of  his  pocket.     She  looked  at  it  as 
if  she  wished  for  a  pinch  of  snuff.    The  physician 


OP  THE  MIND.  >*     125 

put  it  into  her  hands.  Upon  opening  it,  an  artifi- 
cial snake  that  had  been  coiled  up  in  it,  suddenly 
leaped  upon  her  shoulder.  She  was  convulsed 
with  terror,  and  from  that  time  left  off  the  use  of 
opium,  and  rapidly  recovered.  She  lived  forty 
years  afterwards  in  good  health,  and  finally  died 
about  eighty  years  of  age. 

10.  TRAVELING.  Long  journies  should  be  pre- 
ferred to  short  excursions  from  home.  They  re- 
lieve the  mind  from  a  monotony  of  objects,  and 
awaken  a  constant  succession  of  new  ideas. 
They  moreover  create  a  necessity  for  constant 
bodily  exertion,  and  they  remove  the  patient  from 
the  society  of  his  friends,  who,  by  being  obliged 
to  listen  to  his  complaints,  add  fuel  to  the  disease. 

The  journies  in  those  cases  should  be  to  a 
warm  climate,  and  the  patient  should  be  advised, 
before  he  leaves  home,  to  change  every  article  of 
his  dress,  even  the  furniture  of  his  pockets,  that 
he  may  see  nothing  while  abroad,  that  can  revive 
his  disease  by  association. 

In  the  history  of  this  disease  I  remarked  that 
there  is,  in  hypochondriacs,  a  disposition  to  inflict 
pain  upon  their  bodies  by  means  of  wounds,  in 
order  to  suspend  anguish  of  mind.  This  should 


126  ON  THE  DISEASES 

be  prevented  by  removing  all  the  instruments  out 
of  their  way  that  are  usually  employed  for  that 
purpose.  Sometimes  this  anguish  of  mind,  I  have 
said,  leads  its  miserable  subjects  to  seek  to  put 
an  end  to  their  existence  with  their  own  hands. 
This  should  be  prevented,  not  only  by  depriving 
them  of  all  the  means  of  destroying  themselves, 
but  by  securing  the  windows  and  doors  in  which 
they  are  confined,  and  never  permitting  them  to 
be  alone;  also  by  such  other  means  as  accident  or 
design  have  proved  to  be  successful,  and  which 
act  upon  the  mind  through  the  medium  of  the 
body,  and  upon  the  body  through  the  medium  of 
the  mind.  These  are  wine,  blood-letting,  an  un- 
expected sense  of  pain,  compassion,  a  sudden 
and  violent  exertion  of  the  active  power  of  the 
body  and  mind,  terror,  a  sense  of  shame,  and, 
lastly,  infamy.  I  shall  briefly  mention  instances 
of  the  efficacy  of  each  of  them  in  preventing  sui- 
cide. 

1.  A  gentleman  afflicted  with  this  disease  went 
with  a  loaded  pistol  into  a  tavern  in  London,  with 
a  design  to  destroy  himself.  To  conceal  his  in- 
tention, he  called  for  a  small  decanter  of  wine, 
and,  after  locking  the  door  of  the  room  into  which 
he  had  been  conducted,  cocked  his  pistol,  but 
before  he  discharged  its  contents  through  his 


OP  THE  MIND.  127 

head,  determined  to  try  the  quality  of  his  wine. 
Perceiving  it  to  be  very  good,  he  drank  a  second, 
and  then  a  third  glass,  after  which  he  uncocked 
his  pistol,  and  finished  the  whole  decanter.  Find- 
ing such  a  prompt  remedy  for  his  despair  in  this 
cordial  liquor,  he  continued  to  use  it  freely,  and 
was  thereby  cured. 

2.  In  the  year  1803,  I  visited  a  young  gentle- 
man in  our  Hospital,  who  became  deranged  from 
remorse  of  conscience  in  consequence  of  killing  a 
friend  in  a  duel.  His  only  cry  was,  for  a  pistol, 
that  he  might  put  an  end  to  his  life.  I  told  him, 
the  firing  of  a  pistol  would  disturb  the  patients  in 
the  neighbouring  cells,  and  that  the  wound  made 
by  it  would  probably  cover  his  cell  with  blood, 
but  that  I  could  take  away  his  life  in  a  more  easy 
and  delicate  way,  by  bleeding  him  to  death,  from 
a  vein  in  his  arm,  and  retaining  his  blood  in  a 
large  bowl.  He  consented  at  once  to  my  propo- 
sal. I  then  requested  Dr.  Hartshorn,  the  resident 
physician  and  apothecary  to  the  hospital,  to  tie 
up  his  arm,  and  bleed  him  to  death.  The  Doctor 
instantly  feigned  a  compliance  with  this  request. 
After  losing  nearly  twenty  ounces  of  blood,  he 
fainted,  became  calm,  and  slept  soundly  the  en- 
suing night.  The  next  day  when  I  visited  him, 
he  was  still  unhappy;  not  from  despair  and  a 


128  ON  THE  DISEASES 

hatred  of  life,  but  from  the  dread  of  death;  for  he 
now  complained  only,  that  several  persons  in  the 
hospital  had  conspired  to  kill  him.  By  the  conti- 
nuance of  depleting  remedies,  this  error  was  re- 
moved, and  he  was  soon  afterwards  discharged 
from  the  hospital. 

It  will  naturally  occur  to  the  reader,  that  this 
remedy,  and  the  use  of  wine,  should  be  regulated 
by  a  strict  attention  to  the  state  of  the  pulse. 

3.  A  maniac  in  the  Pennsylvania  Hospital  some 
years  ago,  expressed  a  strong  desire  to  drown 
himself.  Mr.  Higgins,  the  present  steward  of  the 
hospital,  seemed  to  favour  this  wish,  and  pre- 
pared water  for  the  purpose.  The  distressed 
man  stripped  himself  and  eagerly  jumped  into  it. 
Mr.  Higgins  endeavoured  to  plunge  his  head  un- 
der the  water,  in  order,  he  said,  to  hasten  his 
death.  The  maniac  resisted,  and  declared  he 
would  prefer  being  burnt  to  death.  "  You  shall 
be  gratified,"  said  Mr.  Higgins,  and  instantly  ap- 
plied a  lighted  candle  to  his  flesh.  "  Stop,  stop," 
said  he,  "  I  will  not  die  now ;"  and  never  after- 
wards attempted  to  destroy  himself,  nor  even  ex- 
pressed a  wish  for  death. 

It  has  been  said  that  persons  who  make  unsuc- 
cessful attempts  to  destroy  themselves,  seldom 


OF  THE  MIND.  ]29 

repeat  them.  If  this  remark  be  true,  I  suspect  it 
is  only  in  those  cases  in  which  the  attempt,  like 
the  one  above  mentioned,  has  been  accompanied 
with  pain. 

4.  The  famous  actress,  Mrs.  Bellamy,  in  an 
hour  of  despair,  was  restrained  from  suicide  by 
hearing  the  cry  of  distress  from  a  child,  near  a 
bridge  from  whence  she  was  preparing  to  throw 
herself  into  the  river  Thames. 

5.  Mr.  Pinel  mentions  an  instance  of  a  gentle- 
man who  was  kept  from  drowning  himself  in  the 
same  river,  by  an  attempt  of  two  or  three  ruffians 
to  pick  his  pocket,  and  which  he  defeated  by  a 
singular  exertion  of  strength  and  courage. 

6.  Zacutus  relates  the  history  of  a  hypochon- 
driac, who  had   made  several  unsuccessful  at- 
tempts to  destroy  himself  by  fire.     His  physician, 
in  order  to  cure  him,  wrapped  him  in  a  fresh 
sheepskin,  which  he  had  previously  wetted  with 
spirit  of  turpentine.      He  applied  fire  to  his  skin, 
which  instantly  enveloped  him  in  a  blaze,  that  so 
terrified  him,  that  he  never  attempted  afterwards 
to  put  an  end  to  his  life. 

7.  Suicide  was  prevented  in  the  virgins  of  Mi- 

17 


130  ON  THE  DISEASES 

letus,  among  whom  it  was  common,  from  the  in- 
fluence of  a  new  and  false  opinion  in  religion,  by 
exposing  their  naked  bodies  in  a  public  part  of 
the  city. 

8.  Dr.  John  Hunter  tells  us,  in  his  account  of 
the  diseases  of  Jamaica,  that  the  negroes,  when 
they  become  deranged,  sometimes  destroy  them- 
selves by  eating  large  quantities  of  earth.  After 
many  fruitless  attempts  to  put  a  stop  to  it,  it  was 
finally  prevented,  by  cutting  off  the  heads  of  the 
negroes  who  died  in  this  manner,  and  exposing 
them  to  view  in  a  public  part  of  the  Island. 

Sometimes  patients,  in  this  state  of  derange- 
ment, destroy  themselves  by  abstinence  from  food 
and  drinks.  I  have  twice  seen  death  induced  in 
this  way  in  the  Pennsylvania  Hospital,  and  once 
in  a  private  patient.  Persuasion  and  force  were 
alike  ineffectual  in  prevailing  upon  them  to  take 
nourishment.  Perhaps  some  such  means  as  the 
following  might  be  more  effectual  for  that  pur- 
pose. 

1.  In  the  Memoirs  of  Count  Maurepas,  it  is 
related  of  the  same  prince  of  Bourbon  who  fan- 
cied himself  to  be  a  plant,  that  he  sometimes  sup- 
posed himself  to  be  dead,  at  which  time  he  re- 


OF  THE  MIND.  131 

fused  to  take  any  food,  for  which  he  said  he  had 
no  further  occasion.  To  cure  this  alarming  de- 
lusion, they  contrived  to  disguise  two  persons, 
who  were  introduced  to  him  as  his  grandfather, 
and  Marshal  Luxemburg,  and  who,  after  convers- 
ing with  him  for  some  time  about  the  shades  that 
inhabited  the  place  of  the  dead,  invited  him  to 
dine  with  Marshal  Turene.  The  prince  followed 
them  into  a  cellar  prepared  for  the  purpose, 
where  he  made  a  hearty  meal,  which  immediate- 
ly restored  him  to  a  belief  that  he  was  alive.  A 
similar  case  of  a  man  being  cured  of  a  belief  that 
he  was  dead,  by  being  prevailed  upon  to  eat,  is 
related  by  Dr.  Turner,  in  his  Treatise  upon  the 
Diseases  of  the  Skin. 

2.  Mr.  Pinel  mentions  an  instance  of  a  man 
who  determined  to  put  an  end  to  his  life  by  ab- 
stinence from  food  only,  but  who  continued  to 
drink  as  usual.     His  attendants  whithheld  drinks 
from  him  until  he  consented  to  take  food  with 
them.     The  bodily  pain  of  thirst,  in  this  case, 
predominated   over  the    anguish   of   the  mind, 
which  had  disposed  him  to  seek  for  death  in  this 
mode  of  suicide. 

3.  Leaving  food  in  a  patient's  cell,  or  room, 
and  carefully  avoiding  importuning  him  to  eat. 


132  ON  THE  DISEASES 

The  constant  sight  of  food  will  tend  to  excite  his 
appetite,  and  a  consciousness  that  he  possesses 
his  free  agency  may  induce  him  to  eat,  when  the 
most  powerful  arguments  for  that  purpose  would 
not  have  that  effect.  I  have  heard  of  a  criminal 
in  Scotland  who  attempted  to  destroy  himself  by 
famine,  in  whom  it  was  completely  prevented  by 
this  practice. 

It  is  a  singular  fact  in  the  history  of  suicide, 
that  it  has  sometimes  been  hereditary  in  families. 
There  are  two  families  in  Pennsylvania,  in  which 
three  of  their  respective  branches  have  perished 
by  their  own  hands,  in  the  course  of  a  few  years. 
Similar  instances  of  this  issue  of  family  derange- 
ment are  to  be  met  with  in  other  countries. 

In  watching  patients,  so  as  to  prevent  their  in- 
juring, or  destroying  themselves,  it  is  of  impor- 
tance to  know  that  the  paroxysm  of  despair  that 
prompts  to  both,  often  comes  on  suddenly,  and  is 
sometimes  preceded  by  unusual  tranquillity  of 
mind,  and  even  by  high  spirits. 


OF  THE  MIND.  133 


CHAPTER  IV. 


Of  dmenomania,  or  the  second  form  of  Partial  Intel- 
lectual Derangement. 

THIS  form  of  madness  is  a  higher  grade  of  hy- 
pochondriasis,  and  often  succeeds  it.  It  differs 
from  it, 

1.  In  the  absence  of  dyspepsia,  or  in  its  cessa- 
tion, in  consequence  of  the  increase  of  morbid 
excitement  in  the  brain,  predominating  over  the 
disease  in  the  stomach. 

2.  In  a  difference,  or  change,  of  the  patient's 
opinions  respecting  his  health,  affairs  and  condi- 
tion.   Instead  of  supposing  himself  to  be  diseased, 
he  now  denies  that  he  has  any  disease ;  and  in- 
stead of  feeling,  or  complaining  of  misery,  he  is 
now  happy  in  the  errors  which  accompany  his 
madness. 

3.  The  errors  in  this  form  of  derangement  are 
more  deeply  seated  than  in  hypochondriasm.    As 


134  ON  THE  DISEASES 

a  proof  of  this,  we  observe,  when  it  arises  from 
love,  the  sight  or  possession  of  the  object  beloved 
relieves  or  cures  it  in  the  latter  disease,  but  it  has 
no  effect  in  the  former.  I  have  seen  it  tried  to 
no  purpose  in  a  young  gentleman  in  this  city. 
Dr.  Nicholas  Robinson  mentions  an  instance,  in 
which  even  the  marriage  of  a  young  woman  to 
the  man  whom  she  loved,  was  so  far  from  curing 
her,  that  she  attempted  to  murder  him  imme- 
diately afterwards. 

Let  it  not  be  supposed  that  amenomania  uni- 
formly succeeds  hypochondriasis.  It  often  pre- 
cedes it,  and  they  both  frequently  blend  their 
symptoms  together.  They  likewise  alternate  with 
each  other.  There  is,  moreover,  now  and  then,  a 
mixture  of  some  of  the  symptoms  of  hysteria  with 
amenomania,  as  well  as  with  hypochondriasis. 
These  successive  changes  and  combinations  of 
those  forms  of  disease  are  to  be  ascribed  to  irrita- 
bility or  inirritability  being  different  in  the  sys- 
tems in  which  they  are  seated,  and,  in  some  in- 
stances, to  their  being  different  in  different  parts 
of  the  same  system. 

Amenomania  is  a  common  form  of  partial  in- 
sanity. We  see  it  in  the  enthusiastic  votaries  of 
all  the  pursuits  and  arts  of  man.  The  alchymists, 


OP  THE  MIND.  135 

the  searchers  after  perpetual  motion,  the  astrono- 
mers, the  metaphysicians,    the    politicians,  the 
knights-errant,  and  the  travellers,  have  all  in  their 
turns  furnished  cases  of  this  form  of  derangement. 
I  once  met  with  a  striking  instance  of  it,  from 
alchymical  pursuits,  in  a  gentleman,  at  the  table 
of  Mr.  Wolfe,  in  London.    He  related  the  issue  of 
several  experiments,  in  which  some  of  the  base 
metals  had  been  converted  into  gold,  and  he  de- 
clared, further,  his  belief,  that  there  was  at  that 
time,  a  man  living  in  India,  whose  life  had  been 
prolonged  above  600  years  by  an  elixir  that  had 
been  discovered  by  an  alchymist.     Upon  other 
subjects  he  was  rational  and  well  informed.     Dr. 
Johnson  has  given  a  just  picture  of  this  disease  in 
the  character  of  an  astronomer  in  his  Rasselas, 
prince  of  Abyssinia.     Several  of  the  nations  of 
Europe  have  lately  furnished  instances   of  men 
deranged,  from  a  belief  in  the  possibility  of  pro- 
ducing perfection  in  human  nature,  and  in  civil 
government,   by   means   of  what    they   absurdly 
called  the  omnipotence  of  human  reason.     But 
we  see  this  disease  of  the  mind  most  frequently  in 
the  enthusiasts  in  religion,  in  whom  it  discovers 
itself  in  a  variety  of  ways ;  particularly, 

1.  In  a  belief  that  they  are  the  peculiar  favour- 
ites of  heaven,  and  exclusively  possessed  of  just 


136  ON  THE  DISEASES 

opinions  of  the  divine  will,  as  revealed  in  the 
Scriptures. 

2.  That  they  see  and  converse  with  angels,  and 
the  departed  spirits  of  their  relations  and  friends. 

3.  That  they  are  favoured  with  visions,  and  the 
revelation  of  future  events.     And, 

4.  That  they  are  exalted  into  beings  of  the 
highest  order.     I  have  seen  two  instances  of  per- 
sons, who  believed  themselves  to  be  the  Messiah, 
and  I  have  heard  of  each  of  the  sacred  names 
and  offices  of  the  Father,  Son,  and  Holy  Ghost, 
having  been  assumed  at  the  same  time  by  three 
persons,  under  the  influence  of  this  partial  form 
of  derangement,  in  a  hospital  in  Mexico. 

There  was  a  time  when  persons  thus  deranged 
were  subjected  to  fines,  imprisonment,  the  extir- 
pation of  their  tongues,  and  even  to  death  from 
fire  and  the  halter.  To  the  influence  of  the  science 
of  medicine  we  are  indebted,  for  teaching  that 
these  opinions  are  generally  as  devoid  of  impiety 
as  an  epileptic  fit;  and  for  consigning,  by  that 
humane  discovery,  the  deluded  subjects  of  them 
to  the  cells  of  a  hospital  instead  of  a  jail,  and  to 
the  hand  of  a  physician,  instead  of  the  hands  of 


OF  THE  MIND.  137 

the  last  officer,  of  what  has  improperly  been  call- 
ed, criminal  justice. 

In  all  these  cases  of  partial  derangement,  the 
understanding  is  not  only  sound  upon  subjects  un- 
connected with  that  which  produced  the  disease, 
but  all  the  other  faculties  of  the  mind  are  unim- 
paired; nor  do  we  observe  the  subjects  of  it,  as 
in  general  madness,  to  be  irritated,  or  unusually 
excited,  by  conversing  upon  the  single  and  origi- 
nal subject  of  their  disease. 

It  is  remarkable  that  all  the  errors  of  amenoma- 
nia  are  the  reverse  of  those  of  tristimania,  form- 
erly mentioned,  in  elevating  the  patient  above  his 
ordinary  rank  and  condition  of  life. 

The  physical  remedies  for  this  form  of  partial 
derangement  are  nearly  the  same  as  those  which 
have  been  recommended  for  tristimania,  particu- 
larly bleeding,  purging,  emetics,  and  low  diet,  in 
an  excited  state  of  the  blood-vessels,  and,  after 
they  are  reduced,  stimulating  diet,  drinks,  and  me- 
dicines, and  a  change  of  company,  pursuits,  and 
climate.  The  errors  which  predominate  in  the 
mind  should  be  soothed,  diverted,  or  opposed  by 
reasoning  or  ridicule,  according  to  their  force. 
There  is  one  error,  which  is  sometimes  opposed 

18 


1  38  ON  THE  DISEASES 

by  reasoning  with  success,  and  that  is,  a  belief, 
which  patients  in  this  pleasant  state  of  derange- 
ment now  and  then  entertain,  that  they  are  favour- 
ed with  extraordinary  revelations,  and  particularly 
a  knowledge  of  future  events.  In  these  cases 
they  should  be  told,  that  supernatural  knowledge 
of  that  kind  has  generally  been  revealed  to  two 
or  more  persons  at  the  same  time,  and  that  it 
has  always  been  accompanied  with  a  power  of 
working  miracles.  Even  the  Saviour  of  the  world 
did  not  rest  the  credibility  of  his  divine  origin,  and 
the  objects  of  his  mission,  upon  his  single  testi- 
mony in  favour  of  himself,  nor  yet  upon  the 
supreme  and  miraculous  power  he  exercised  over 
spirit  and  matter;  but  condescended  to  receive 
the  testimony  of  his  twelve  apostles  in  favour  of 
the  former,  and  compelled  a  belief  in  the  latter, 
by  endowing  them  with  a  power,  similar  to  his 
own,  over  all  the  operations  of  nature. 

Both  tristimania  and  amenomania  often  con- 
tinue for  months  and  years,  in  the  form  in  which 
they  have  been  described,  but  they  are  as  often 
followed  by  derangement  in  every  part  of  the  un- 
derstanding, and  in  all,  or  a  part  of,  the  other 
faculties  of  the  mind.  When  this  is  the  case,  it 
is  called  GENERAL  MADNESS,  which  is  the  next  sub- 
ject of  our  inquiries  and  observations. 


OF  THE  MIND.  139 


CHAPTER  V. 


Of  General  Intellectual  Derangement. 


I  SHALL  divide  this  general  form  of  derange- 
ment into  three  grades  or  states. 

I.  MANIA,  by  which  I  mean  what  has   been 
called  tonic  madness  by  some  writers,  and  ma- 
nia furibunda  by  Vanswieten. 

II.  MANICULA,  or  madness  in   a  reduced,  and 
most  commonly,  in  a  chronic  state. 

III.  MANALGIA,  or  that  state  of  general  mad- 
ness, in  which  a  universal  torpor  takes  place  in 
the  body  and  mind. 

This  division  of  gejieral  madness  into  three 
states,  accords  with  similar  divisions,  which  have 
lately  been  adopted  of  several  other  diseases,  par- 
ticularly rheumatism,  and  inflammation  of  the 


140  ON  THE  DISEASES 

liver.  The  former  is  known  by  the  names  of 
rheumatismus,  rheumaticula,  and  rhcumatalgia, 
ana1  the  latter  by  the  names  of  hepatitis,  hepati- 
cula,  and  hepitalgia.  The  propriety  of  thus  con- 
forming madness  to  the  divisions  of  those  two 
diseases  will  appear  when  we  consider  the  unity 
of  their  proximate  cause,  and  that  they  all  depend 
upon  similar  morbid  actions  in  the  blood-vessels. 
Rheumatism  and  hepatitis,  therefore,  may  be  con- 
sidered, if  I  may  be  allowed  the  illustration,  as 
madness  in  the  joints,  or  liver;  and  madness,  as 
rheumatism,  or  hepatitis,  in  the  brain. 

I.  I  shall  begin  with  the  history  and  cure  of 
general  madness  of  the  first  grade,  or  of  what  I 
have  called  MANIA.  Its  premonitory  signs  are, 
watchfulness,  high  or  low  spirits,  great  rapidity  of 
thought,  and  eccentricity  in  conversation  and 
conduct;  sometimes  pathetic  expressions  of  hor- 
ror, excited  by  the  apprehension  of  approaching 
madness;  terrifying  or  distressing  dreams;  a 
great  irritability  of  temper ;  jealousy ;  instability 
in  all  pursuits;  unusual  acts  of  extravagance, 
manifested  by  the  purchases  of  houses,  and  cer- 
tain expensive  and  unnecessary  articles  of  furni- 
ture, and  hostility  to  relations  and  friends.  The 
face  is  pale  or  flushed,  the  eyes  are  dull,  or  wild, 
the  appetite  is  increased,  the  bowels  are  costive, 


OF  THE  MIND.  141 

and  the  patient  complains  sometimes  of  throb- 
bing in  the  temples,  vertigo,  and  headach.  The 
gentleman  formerly  mentioned,  in  whom  madness 
was  excited  by  a  number  of  small  shot  lodged  in 
his  foot,  when  a  school-boy  was  afflicted  with 
deafness.  A  sudden  return  of  his  hearing  was 
always  a  premonitory  sign  of  an  approaching 
attack  of  derangement. 

The  remedies  in  this  case  should  be, 

1.  The  removal  of  all  the  remote  and  exciting 
causes  of  the  disease,  and  particularly  to  abstract 
the  patient  from  study  and  business,  if  they  have 
produced  it,  and  to  substitute  in  their  room  re- 
laxation and  amusements.     Dr.  Boerhaave  once 
passed  several  weeks  without  sleep,  and  disco- 
vered other  signs  of  approaching  derangement. 
He  was  cured  by  being  torn  from  his  books,  and 
allured  into  agreeable  company. 

2.  Changing  the  subject  of  our  patient's  stu- 
dies, when  they  are  abstruse  and  difficult,  to  such 
as  are  of  a  lighter  nature.     Rousseau   often  re- 
moved, by  this  means,  the  premonitory  symptoms 
of  madness.     The  celebrated  Mr.  M'Laurin,  the 
friend   and   cotemporary   of  Sir   Isaac   Newton, 
made  it  a  practice  to  relieve  his  mind,  when  de- 


142  ON  THE  DISEASES 

bilitated  by  hard  study,  and  thereby  predisposed 
to  this  disease,  by  reading  novels  and  romances 
and  such  was  his  knowledge  of  them,  that  the  late 
Dr.  Gregory  informed  me  he  was  often  appealed 
to  for  the  character  of  every  work  of  that  kind 
that  appeared  in  the  English  language. 

3.  Low  diet,  and  a  few  gentle  doses  of  purging 
physic,  and,  if  the  pulse  be  full  or  tense,  the  loss 
of  ten  or  twelve  ounces  of  blood.  By  means  of 
these  remedies,  I  have  in  many  instances  pre- 
vented an  attack  of  madness. 

The  symptoms  of  this  state  of  derangement, 
when  completely  formed,  as  they  appear  in  the 
body,  are,  a  wild  and  ferocious  countenance,  en- 
larged and  rolling  eyes,  constant  singing,  whist- 
ling or  hallooing,  imitation  of  the  noises  of  dif- 
ferent animals ;  walking  with  a  quick  step,  or 
standing  still,  often  with  the  hands  and  eyes  ele- 
vated towards  the  heavens ;  wakefulness  for  whole 
nights,  weeks,  months,  and,  according  to  Dr. 
Morely's  account  of  a  boy  at  Naples,  for  years ; 
great  muscular  strength,  uncommon  adroitness  in 
performing  certain  acts,  and  uncommon  swiftness 
in  running.  The  nerves  are  insensible  to  cold, 
heat,  and  to  irritants  of  all  kinds.  1  am  aware 
that  insensibility  to  cold  is  denied  by  Mr.  Halsam 


OF  THE  MIND.  143 

to  be  a  symptom  of  general  madness.  I  admit 
that  it  does  not  take  place  in  one  of  its  states, 
that  is,  in  manicula,  but  it  is  uniformly  present, 
as  I  shall  prove  by  facts  hereafter,  in  its  highest 
and  lowest  grades,  in  which  states  the  system 
resists  not  cold  only,  and  heat,  but  all  the  usual 
remote  causes  of  fever  from  the  insensible  quali- 
ties of  the  atmosphere.  Sometimes  the  nerves 
exhibit,  in  great  mobility,  several  of  the  signs  of 
hysteria  mixed  with  general  madness.  The  chief 
of  these  signs  are  laughing  and  weeping.  They 
occur  oftener  in  women  than  men. 

The  skin  is  dry,  cool,  and  sometimes  covered 
with  profuse  sweats.  »A  coldness  often  affects 
the  feet  only,  for  days  and  weeks,  while  the  head, 
and  other  parts  of  the  body  are  preternaturally 
warm,  or  of  their  natural  temperature. 

The  senses  of  hearing  and  seeing  are  uncom- 
monly acute.  This  is  obvious,  from  their  hearing 
so  distinctly  low  and  distant  sounds,  and  from 
their  prompt  recollection  of  long  unseen  and  for- 
gotten faces,  and  of  the  resemblance  of  persons, 
whom  they  have  never  seen  before,  to  their 
parents,  or  to  some  other  of  their  ancestors. 


144  ON  THE  DISEASES 

The  tongue  is  generally  moist,  and  frequently 
has  a  whitish  appearance,  such  as  occurs  in  com- 
mon fevers.  There  is  sometimes  a  preternatural 
secretion  of  saliva  and  mucus  in  the  mouth  and 
throat,  which  is  of  a  viscid  nature,  and  discharged 
with  difficulty  by  spitting.  From  the  constancy 
of  this  symptom  in  some  mad  people,  they  ob- 
tained the  name  of  sputatorep,  or  spitters.  There 
is  generally  a  stoppage  of  the  secretion  of  mucus 
in  the  nose. — Dr.  Moore  found  this  to  be  the  case 
in  two-thirds  of  all  the  maniacs  in  the  Pennsylva- 
nia Hospital,  whom  he  examined  at  my  request, 
with  a  reference  to  this  symptom.  Where  this 
secretion  was  not  suspended,  he  found  the  mucus 
of  the  nose  dry  arid  hard* 

The  appetite  for  food  is  great,  or  there  is  a 
total  want  of  it.  The  bowels  are  generally  cos- 
tive, and  the  stools  white,  small  and  hard.  The 
urine  is  scanty  in  quantity,  and,  for  the  most  part, 
of  a  high  colour. 

The  pulse  is  synocha,  intermitting,  preternatu- 
rally  slow,  frequent,  quick,  depressed,  or  mor- 
bidly natural,  exactly  as  we  find  it  in  other  arte- 
rial diseases  of  great  morbid  action.  It  is  gene- 
rally depressed,  where  the  muscles  are  in  a  state 
of  violent  excitement. 


OF  THE  MIND.  145 

The  symptoms  of  mania,  as  they  appear  in  the 
mind,  vary  with  its  causes.     When  it  is  induced 
by  impressions  that  have  been  made  upon  the 
brain  through  the  medium  of  the  heart,  all  the 
faculties  of  the  mind  discover  marks  of  the  dis- 
ease in  all  their  operations.     In  its  highest  grade, 
it  produces  erroneous  perception.     In  this  state 
of  derangement,  the  patient  mistakes  the  persons 
and  objects  around  him.     This  may  arise  either 
from  a  disease  in  the  external  senses,  in  which 
case  it  is  called  morbid  sensation;  or  from  a  dis- 
ease in  the  brain.     It  is  when  it  arises  from  the 
latter  cause  only,  a  symptom  of  the  first  or  higher 
grade  of  intellectual  derangement.     We  have  a 
striking  illustration  of  this  diseased  state  of  per- 
ception in  the  character  of  Ajax,  in  the  tragedy 
of  Sophocles.     He  becomes  mad,  in  consequence 
of  Ulysses  being  preferred  to  him  in  the  compe- 
tition for  the  arms  of  Achilles.     In  one  of  his 
paroxysms  of  madness,  he  runs  into   the  fields, 
and  slays  a  number  of  shepherds  and  their  cattle, 
under  a  belief  that  they  were  Agamemnon,  Me- 
nalaus,  and  others,  who  had  been  the  instruments 
of  his  dishonour.     Afterwards  he  brings  a  number 
of  cattle  to  his  tent,  and  among  them  a  large 
ram,  which  he  puts  to  death  for  his  rival  and 
antagonist  Ulysses.     Persons  under  the  influence 
of  this  grade   of  madness,  sometimes   mistake 

19 


146  ON  THE  DISEASES 

their  friends  for  strangers,  and  common  visiters 
for  their  relations  and  friends.     They  now   and 
then  fancy  they  see  good  or   bad   spirits    stand- 
ing by  their  bed-sides,  waiting  to  carry  them  to  a 
place   of  torment   or  happiness,    according    as 
their  moral  dispositions  and  habits  in  health  have 
prepared  them   for    those    different  abodes    of 
wicked  or  pious  souls.     Not  only  the  eyes,  but 
the  ears  likewise,  are  the  vehicles  of  false  per- 
ceptions, and  to   these  we   are   to  ascribe  the 
soliloquies  we  sometimes  observe  in  mad  people. 
They  fancy  they  are  spoken  to,  and  their  conver- 
sation frequently  consists  of  replies  only  to  certain 
questions  they  suppose  to  be  put  to  them.     These 
false  perceptions  are  more  common  through  the 
ears  than  the  eyes  in  mad  people.     The  latter 
occur  constantly  more  or  less  in  delirium,  but  we 
occasionally  see  them  in  the  highest  grade  of  in- 
tellectual madness.     When  these  errors  in  per- 
ception take  place,  madness  has  been  called  ideal 
by  Dr.  Arnold,  but,  more  happily,  diseased  percep- 
tion by  Dr.  Creighton.     It  is  in  this  state  of  mad- 
ness  only  that  it  is  proper  to  say,  persons  are 
"out  of  their  senses;"  for  the  mind  no  longer 
receives  the  true  images  of  external  objects  from 
them. 

To  account  for  these  erroneous  or  diseased  per- 


OP  THE  MIND.  147 

ceptions,  it  will  be  necessary  to  remark,  that  the 
correspondence  of  ideas  and  thoughts,  with  im- 
pressions, depends  upon  the  sameness  of  the  im- 
pressions, which  produced  the  original  ideas  and 
thoughts.  Now  this  correspondence  can  take 
place  only  when  the  brain  is  in  a  healthy  state. 
When  it  is  diseased,  impressions  induce  unrelated 
ideas  and  thoughts,  as  in  the  case  of  Ajax  just 
now  mentioned.  It  will  be  necessary  to  remark 
further  in  this  place,  that  no  idea  can  be  excited 
in  the  mind,  however  erroneous  it  may  be,  from  a 
want  of  relation  between  impression  and  percep- 
tion, that  did  not  pre-exist  in  the  mind.  Ajax 
could  not  have  fancied  a  large  ram  to  be  Ulysses, 
had  not  his  image  from  a  former  impression  of 
his  person  upon  his  brain,  pre-existed  in  his 
mind;  and  it  was  because  the  part  of  his  brain 
which  was  stimulated  by  the  image  of  the  ram 
did  not  emit  a  corresponding  perception,  but  con- 
veyed the  motion  excited  by  it  to  that  part  of  the 
brain  in  which  the  image  of  Ulysses  had  been 
imprinted,  that  he  saw  him  instead  of  a  ram. 
The  nature  of  this  error  of  perception  may  be 
understood,  by  recollecting  how  often  impressions 
upon  a  sound  part  of  the  body  produce  sensation 
and  motion,  in  parts  that  are  affected  with  a  mor- 
bid sensibility  and  irritability,  that  are  remote 


148  ON  THE  DISEASES 

from  it.  These  errors,  as  applied  to  the  body, 
have  lately  received  the  names  of  error  sensus, 
and  error  motus.  They  occur  in  all  the  senses 
as  well  as  in  the  nerves,  muscles  and  brain. 

Where  these  erroneous  perceptions  do  not  take 
place,  the  associations  of  a  madman  are  often  dis- 
cordant, ludicrous,  or  offensive,  and  his  judgment 
and  reason  are  perverted  upon  all  subjects.  He 
sometimes  attempts  to  injure  himself  or  others. 
Even  inanimate  objects,  such  as  his  clothing,  bed, 
chairs,  tables,  and  the  windows,  doors,  and  walls 
of  his  room,  when  confined,  partake  of  his  rage. 
All  sense  of  decency  and  modesty  is  suspended; 
hence  he  besmears  his  face  with  his  own  excre- 
tions, and  exposes  his  whole  body  without  a 
covering.  When  he  roams  at  large,  or  escapes 
from  a  place  of  confinement,  lonely  woods, 
marshes,  caves,  or  graveyards*  are  his  usual 
places  of  resort,  or  retirement.  What  is  called 
consciousness  is  at  this  time  destroyed  in  his 
mind.  He  is  ignorant  of  the  place  he  occupies, 
and  of  his  rank  and  condition  in  society,  of  the 
lapse  of  time,  and  even  of  his  own  personal 
identity.  Shakspeare  has  very  happily  described 
a  part  of  this  state  of  mind,  when  he  makes  King 
Lear  utter  the  following  words : 


OF  THE  MIND.  149 

"  I  am  mainly  ignorant 

What  place  this  is  ;  and  all  the  skill  1  have 
Remembers  not  these  garments,  nor  I  know  not 
Where  I  did  sleep  last  night." 

This  grade  of  derangement  is  generally  of  short 
duration.  It  gradually  leaves  the  memory,  and 
appears  with  less  force  in  the  passions  and  moral 
faculties,  but  still  occupies,  in  a  greater  or  less 
degree,  every  part  of  the  understanding. 

The  sameness  in  the  operations  of  nature,  in 
thus  gradually  contracting  the  seat  and  extent  of 
this  disease  to  one  faculty  of  the  mind,  and  in 
contracting  the  seat  and  extent  of  violent  fevers 
to  the  blood-vessels,  was  noticed  in  a  former  part 
of  these  Inquiries. 

In  this  reduced  state  of  madness,  the  mind  be- 
comes more  coherent,  and  perceives,  and  asso- 
ciates correctly,  but  judges  incorrectly,  that  is, 
draws  erroneous  conclusions  from  false  premises. 
But  there  are  cases  in  this  reduced  grade  of  de- 
rangement in  which  the  patient  perceives  justly, 
associates  naturally,  judges  correctly,  but  rea- 
sons erroneously,  that  is,  draws  false  conclusions 
from  just  propositions.  Sometimes  he  discovers 
the  reverse  of  this  state  of  mind,  by  drawing  just 
conclusions  from  erroneous  perceptions,  associ- 


150  ON  THE  DISEASES 

ations  and  judgments.  Thus,  when  he  fancies 
himself  to  be  a  king,  he  errs  in  all  the  ways  that 
have  been  mentioned.  But  observe  his  conduct; 
he  covers  himself  with  a  blanket  which  he  calls 
a  robe,  he  puts  a  mat  upon  his  head  which  he 
calls  a  crown,  struts  with  a  majestic  step,  and 
demands  the  homage  due  to  royalty  from  all 
around  him.  In  this  respect  he  reasons  justly 
from  false  premises,  and  acts  conformably  to  the 
high  opinion  he  entertains  of  his  rank  and  power. 
In  a  more  advanced  state  of  the  disease,  the  hos- 
tility of  the  patient  is  confined  to  his  friends  and 
relations  only,  and  this  is  frequently  great  in  pro- 
portion to  the  nearness  of  the  connection,  and 
the  extent  of  the  obligations  he  owes  to  them. 
Its  intensity  can  not  be  conceived  of  by  persons 
who  have  observed  that  passion  only  in  ordinary 
life.  I  once  advised  a  ride  in  a  chair,  for  one  of 
my  private  patients  in  this  state  of  mind,  in  the 
Pennsylvania  Hospital.  Before  he  got  into  it,  he 
made  the  steward  of  the  hospital,  who  was  to 
accompany  him,  declare,  that  no  one  of  his  family 
had  ever  rode  in  it.  But  further,  while  the  dis- 
ease occupies  the  whole  understanding,  the  pa- 
tient discovers  more  derangement  in  talking  upon 
some  subjects  than  others.  These  subjects  are 
sometimes  of  a  pleasant,  but  oftener  of  a  distress- 
ing nature.  The  disease  varies  with  each  of 


OF  THE  MIND.  151 

them  by  putting  on  the  appearance  of  amenoma- 
nia  in  the  former  and  tristimania  in  the  latter 
case.  It  differs  from  them  both  in  the  errors 
and  prejudices  that  are  entertained  by  the  patient, 
being  accompanied  with  more  corporeal  and  men- 
tal excitement;  in  being  less  fixed  to  one  object, 
and  in  occupying  every  part  of  the  understand- 
ing. 

From  a  part  of  the  brain  being  preternaturally 
elevated,  but  not  diseased,  the  mind  sometimes 
discovers  not  only  unusual  strength  and  acuteness, 
but  certain  talents  it  never  exhibited  before.  The 
records  of  the  wit  and  cunning  of  madmen  are 
numerous  in  every  country.  Talents,  for  elo- 
quence, poetry,  music,  and  painting,  and  uncom- 
mon ingenuity  in  several  of  the  mechanical  arts, 
are  often  evolved  in  this  state  of  madness.  A 
gentleman  whom  I  attended  in  our  hospital  in  the 
year  1810,  often  delighted,  as  well  as  astonished, 
the  patients  and  officers  of  our  hospital,  by  his 
displays  of  oratory,  in  preaching  from  a  table  in 
the  hospital-yard  every  Sunday.  A  female  patient 
of  mine,  who  became  insane  after  parturition  in 
the  year  1807,  sang  hymns  and  songs  of  her 
own  composition,  during  the  latter  stage  of  her 
illness,  with  a  tone  of  voice  so  soft  and  pleasant, 
that  1  hung  upon  it  with  delight,  every  time  I 


152  ON  THE  DISEASES 

visited  her.  She  had  never  discovered  a  talent 
for  poetry  nor  music  in  any  previous  part  of  her 
life.  Two  instances  of  a  talent  for  drawing, 
evolved  by  madness,  have  occurred  within  my 
knowledge:  and  where  is  the  hospital  for  mad 
people,  in  which  elegant  and  completely  rigged 
ships,  and  curious  pieces  of  machinery  have  not 
been  exhibited,  by  persons  who  never  discovered 
the  least  turn  for  a  mechanical  art  previously  to 
their  derangement.  Sometimes  we  observe  in 
mad  people  an  unexpected  resuscitation  of  know- 
ledge ;  hence  we  hear  them  describe  past  events, 
and  speak  in  ancient  or  modern  languages,  or 
repeat  long  and  interesting  passages  from  books, 
none  of  which,  we  are  sure,  they  were  capable  of 
recollecting,  in  the  natural  and  healthy  state  of 
their  minds. 

The  disease  which  thus  evolves  these  new  and 
wonderful  talents  and  operations  of  the  mind,  may 
be  compared  to  an  earthquake,  which,  by  con- 
vulsing the  upper  strata  of  our  globe,  throws  upon 
its  surface  precious  and  splendid  fossils,  the  ex- 
istence of  which  was  unknown  to  the  proprietors 
of  the  soil  in  which  they  were  buried. 

Sometimes  the  cause  which  induced  derange- 
ment is  forgotten,  and  the  subjects  of  the  ravings, 


OF  THE  MIND.  153 

as  well  as  the  conduct  of  patients,  are  contrary  to 
their  usual  habits ;  but  they  both  more  frequently 
accord  with  their  natural  tempers  and  disposi- 
tions, and  with  the  cause  of  their  disease. 

Are  they  naturally  proud  and  ambitious  ?  They 
imagine  themselves  to  be  kings  or  noblemen,  and 
demand  homage  and  respect.    Are  they  naturally 
avaricious  ?  They  fancy  they  possess  incalculable 
wealth.    Are  they  ferocious  and  malicious  ?  They 
assume  the  nature  of  wild  beasts,  and  attempt  to 
injure  their  friends  and  keepers.     Are  they  sen- 
sual and  slovenly  in  their  dispositions  and  dress  ? 
They  discover  marks  of  both  in  their  conversa- 
tion and  appearance.     Are  they  pious  and  bene- 
volent ?  They  are  inoffensive  in  their  deportment, 
and  spend  much  time  in  devotional  exercises. — 
But  the   conduct  and  language  of  madmen  are 
much  influenced  by  the  specific  cause  that  in- 
duces it.     Does  it  arise   from   reciprocal  love, 
opposed  in  the  object  of  mutual  wishes  by  inte- 
rested friends  ?    It  vents  itself  in  sighs  and  songs, 
or  sonnets  and  love  letters.     Is  madness  induced 
by  perfidy  in  a  lover?  It  discovers  itself  in  all  the 
usual  marks  of  resentment,  rage,  and,  when  prac- 
ticable, of  revenge.     Ariosto  has  with  great  ele- 
gance and  correctness  described  these  marks  in 
the  conduct  of  Orlando,  when  deserted  by  his  be- 

20 


154  ON  THE  DISEASES 

loved  Angelica.  He  lies  down  upon  a  bed  in 
order  to  rest  a  few  minutes,  but  the  moment  he 
recollects  that  Angelica  once  slept  upon  that  bed, 
he  instantly  starts  from  it,  tears  up  the  tree  by  the 
roots  upon  which  she  had  cut  her  name,  and 
finally  dries  up  the  water  in  which  she  had  been 
accustomed  to  view  her  face. 

Has  the  disease  been  induced  by  a  conflict  be- 
tween the  moral  faculty,  and  the  sexual  appetite, 
or  by  the  undue  gratification  of  it  ?  The  habitual 
and  morbid  impurity  of  the  mind  discovers  itself 
in  corresponding  conversations  and  actions.  Se- 
veral cases  of  this  kind  in  both  sexes,  have  occur- 
red in  our  hospital. 

But,  further,  is  madness  induced  by  the  ingra- 
titude or  treachery  of  friends,  or  by  the  unjust 
calumnies  of  the  world  ?  The  conversation  and 
conduct  of  the  patient  indicate  a  coldness  or  hos- 
tility to  the  whole  human  race.  In  this  state  of 
mind,  the  walls  of  a  cell,  and  even  darkness,  are 
welcomed,  to  protect  the  miserable  sufferer  from 
the  sight  of  the  supposed  monster — man. 

Mr.  Merry  has  very  forcibly  described  the  feel- 
ings of  a  person  deranged  from  this  cause,  in  the 
following  lines : 


OP  THE  MIND.  155 

"  By  sharp  sensation  wounded  to  the  soul, 
He  ponders  on  the  world  ;  abhors  the  whole. 
In  the  dire  working  of  his  wakeful  dreams, 
The  human  race,  a  race  of  demons  seems. 
All  is  unjust,  discordant  and  severe  ; 
He  asks  not  mercy's  smile,  nor  pity's  tear." 

Is  it  induced  by  misfortunes  in  business,  and  by 
the  rapacity  and  cruelty  of  creditors?  He  sees  a 
sheriff,  or  one  of  his  deputies,  in  every  person  that 
opens  his  door,  and  talks  of  nothing  but  the  hor- 
rors of  a  jail.  Mr.  Merry  has  described  this  state 
of  mind  likewise,  with  great  correctness  in  the 
following  lines. 

"  But  most  to  him  shall  memory  prove  a  curse, 
Who  meets  capricious  fortune's  sad  reverse. 
Who  once,  in  wealth,  indulged  each  gay  desire, 
While  to  possess,  was  only  to  require. 
Who  scattered  bounty  with  a  liberal  hand. 
And  rov'd,  at  will,  through  pleasure's  flow'ry  land ; 
By  ruin  cast  amongst  the  lowly  crew, 
What  doleful  visions  pass  before  his  view  ! 
His  taste,  his  worth,  his  wisdom  disappear, 
His  virtues,  too,  none  notice,  none  revere, 
Cold  is  the  summer  friend,  who  lived  to  trace 
His  playful  fancy's  ever  varying  grace. 
Even  nature's  self  a  different  aspect  wears, 
Dimm'd  by  the  mists  of  slow  consuming  cares, 
Glows  not  a  flower,  nor  pants  a  vernal  breeze, 
As  in  his  hours  of  affluence  and  ease. 
While  every  luxury  that  the  world  displays, 
Wounds  him  afresh,  and  tells  of  better  days." 


156  ON  THE  DISEASES 

Is  madness  induced  by  remorse  for  real  and 
imaginary  crimes?  The  wretched  sufferer  fan- 
cies his  bed-room  a  dungeon,  and  his  physician 
an  executioner ;  or  he  cries  out  to  be  delivered 
from  infernal  spirits,  which  he  supposes  to  be 
waiting  around  his  bed,  to  carry  his  soul  to  a 
place  of  torment. 

It  is  induced  by  false  and  gloomy  opinions  of 
the  attributes  of  the  Deity,  and  a  belief  of  being 
destined  to  endless  misery?  His  apartment  be- 
comes vocal  day  and  night  with  the  groans  and 
sighs,  and  the  excruciating  language  of  despair. 

It  is  brought  on  by  a  belief  in  his  being  a  pecu- 
liar favourite  of  heaven,  and  destined  to  fulfil 
some  of  its  high  and  benevolent  decrees?  His 
mind  overflows  with  enthusiastic  joy,  and  he 
stands  aloof  from  an  intercourse,  and  even  from 
the  contact  of  mortals.  Two  instances  of  this 
kind  have  come  under  my  knowledge  in  this  city. 

Has  the  sudden  and  unexpected  acquisition  of 
great  wealth  perverted  the  natural  operations  of 
the  mind  ?  The  maniac  from  this  cause  is  elevated, 
cheerful,  sings  and  laughs  from  morning  till  night. 
I  have  seen  one  instance  of  this  state  of  madness 
in  our  hospital,  from  the  cause  I  have  mentioned. 


OP  THE  MIND.  157 

It  is  from  such  cases  of  madness,  that  it  has  been 
said  to  be  attended  with  pleasure.  Horace's 
madman  complained  of  his  physician,  for  restor- 
ing him  to  his  former  humble  grade  of  life,  by 
curing  him,  and  Dr.  Thomas  Willis  mentions  an 
instance  of  a  man,  who  was  so  happy  in  his  pa- 
roxysms of  madness,  that  when  he  was  well  he 
longed  with  impatience  for  their  return ;  but  such 
instances  of  happiness  in  madness  are  very  rare. 
It  is  more  frequently,  I  shall  say  hereafter,  accom- 
panied with  misery  or  a  total  insensibility  to  it. 

The  nature  of  a  paroxysm  of  madness  is  much 
diversified,  by  its  affecting  the  moral  faculties,  or 
leaving  them  in  a  sound  state.  Shakspeare  has 
happily  illustrated  the  encroachment  of  intellec- 
tual madness  upon  the  moral  faculty,  and  the 
sudden  recovery  of  its  correct  state,  in  the  follow- 
ing lines,  which  he  makes  his  man,  King  Lear,  to 
utter  upon  being  called  upon  to  punish  one  of  his 
subjects  for  adultery. 

"  Thou  shalt  not  die — die  for  adultery! 
No ! — to  it  luxury — pell  mell — 
For  I  want  soldiers." 

And  then,  as  if  suddenly  penetrated  with  a  sense 
of  the  indecency  of  what  he  had  said,  he  adds, 


158  ON  THE  DISEASES 

«  Fie  ! Fie ! Fie ! Pah ! 

Give  me  an  ounce  of  civet,  good  apothecary, 
To  sweeten  my  imagination." 

The  reader  will  excuse  my  frequent  recurrences 
to  the  poets  for  facts  to  illustrate  the  history  of 
madness.  They  view  the  human  mind  in  all  its 
operations,  whether  natural  or  morbid,  with  a 
microscopic  eye,  and  hence  many  things  arrest 
their  attention,  which  escape  the  notice  of  phy- 
sicians. 

To  the  history  that  has  been  given  of  the  cor- 
respondence between  the  ravings  and  conduct  of 
mad  people,  and  their  natural  tempers  and  dispo- 
sitions, there  are  several  exceptions.  These  are, 
all  those  cases  in  which  persons  of  exemplary 
piety  and  purity  of  character,  utter  profane,  or 
impious,  or  indelicate  language,  and  behave  in 
other  respects  contrary  to  their  moral  habits. 
The  apparent  vices  of  such  deranged  people  may 
be  compared  to  the  offensive  substances  that  are 
sometimes  thrown  upon  the  surface  of  the  globe 
by  an  earthquake,  mixed  with  the  splendid  fos- 
sils formerly  mentioned,  which  substances  had 
no  existence  in  nature,  but  were  formed  by  a 
new  arrangement  in  the  particles  of  matter  in 


OF  THE  MIND.  159 

consequence  of  the  violent  commotions  in  the 
bowels  of  the  earth. 

Not  only  the  ravings  of  mad  people,  for  the 
most  part,  accord  with  their  habitual  tempers  and 
dispositions,  and  the  causes  of  their  disease,  but 
their   conduct  corresponds  in  like  manner  with 
their    habitual    occupations.     The    lawyer,    the 
physician,   and   the   minister  of  the  gospel,  fre- 
quently employ  themselves  in  the  exercises  of 
their  several  professions.     The  merchant  spends 
much  of  his  time  in  making  out  invoices,  and  in 
writing  letters,  the  politician  devours  a  daily  news- 
paper; the  poet  writes  verses;  and  the  painter 
draws  pictures  upon  the  walls  of  their  respective 
cells;  the  mechanic  cuts  out  houses,  ships,  car- 
riages, and  bridges,  from  pieces  of  sticks,  with 
his  penknife;   the  sailor  heaves  his  log   or   his 
line;  and  the   soldier  goes  through  his   manual 
exercise  with  a  cane,  and  never  fails  to  salute  his 
visiters  by  lifting  the  back  of  his  hand  to  the  side 
of  his  head. 

These  habitual  actions  seldom  take  place  until 
the  disease  has  subsided,  in  a  considerable  de- 
gree, in  the  temper  and  passions. 

After  the  detail  of  the  symptoms  of  general 
madness  that  has  been  given,  I  feel  disposed  to 


160  ON  THE  DISEASES 

look  back  for  a  few  minutes,  and  contemplate, 
with  painful  and  melancholy  wonder,  the  immense 
changes  in  the  human  mind,  that  are  induced  by 
a  little  alteration  in  the  circulation  of  the  blood 
in  the  brain.  What  great  effects  are  produced  in 
this  instance  by  little  causes !  How  slender  the 
tenure  by  which  we  hold  our  intellectual  and 
moral  existence !  and  how  humiliating  our  situa- 
tion from  its  loss !  Well  might  the  eloquent  Mr. 
Cowper,  from  this  view  of  the  mind  of  man,  con- 
sider it  as 

"  A  harp,  whose  chords  elude  the  sight, 

Each  yielding  harmony,  dispos'd  aright. 

The  screws  revers'd  !  (A  task,  which,  if  he  please, 

God  in  a  moment  executes  with  ease) 

Ten  thousand  times  ten  thousand  strings  go  loose ; 

Lost,  till  he  tune  them,  all  their  power  and  use." 

There  is  a  considerable  variety  in  the  forms  of 
general  madness.  It  appears, 

I.  In  a  single,  acute  and  violent  paroxysm,  such 
as  has  been  described,  which  continues  for  days, 
weeks,  and  sometimes  months,  and  ends  in  death, 
a  remission,  or  a  perfect  and  durable  recovery. 
In  one  of  the  cases  of  a  protracted  paroxysm  of 
madness  which  came  ander  my  notice,  the  dis- 
ease continued  from  June  1810  until  April  1811, 


OF  THE  MIND.  161 

with  scarcely  any  abatement  in  the  excitement  of 
the  body  and  mind,  notwithstanding  the  patient 
was  constantly  under  the  operation  of  depleting 
remedies.  I  have  seen  another  case,  in  which 
the  same  remedies  were  insufficient  to  produce 
an  interruption  of  five  minutes  of  speech  or  voci- 
ferations, except  during  a  few  short  intervals  of 
sleep,  for  two  months. 

II.  General  madness  appears  in  a  chronic,  but 
more  moderate  form,  without  paroxysms. 

HI.  It  appears  with  paroxysms,  with  chronic, 
but  moderate,  derangement  in  its  intervals.  In 
these  intervals,  the  patient  sometimes  recovers 
so  far  as  to  discover  derangement  upon  one  sub- 
ject only.  In  these  cases  a  return  of  general 
madness  is  easily  excited  at  any  time,  by  touching 
upon  the  subject  of  his  partial  insanity  in  con- 
versing with  him.  Thus  the  touch  of  one  of  the 
chords  of  a  musical  instrument  causes  all  its 
chords  to  vibrate  with  it.  In  this,  1  remarked 
formerly,  general  madness  differs  from  the  two 
forms  of  partial  madness  which  have  been  de- 
scribed. 

IV.  It  appears  in  paroxysms,  with  the  restora- 
tion of  reason  in  their  intervals.  These  parox- 

21 


162  ON  THE  DISEASES 

ysms  occur  annually,  or  at  longer  intervals,  twice 
a  year,  particularly  during  the  equinoxes,  monthly, 
weekly,  and  according  to  Lazoni,  an  Italian  phy- 
sician, every  day.  Perhaps  this  diurnal  attack  of 
madness  was  what  has  lately  been  called  the  ma- 
niacal state  of  fever. 

* 

Successive  paroxysms  of  madness,  with  perfect 
intervals  between  them,  occur  most  frequently  in 
habitual  drunkards;  and  they  would  probably  oc- 
cur much  oftener,  were  they  not  prevented  by  a 
vicarious  affection  of  the  stomach,  known  by 
puking,  redness  of  the  eyes,  an  active  pulse,  and  a 
peculiar  and  specific  fcetor  of  the  breath.  From 
the  correspondence  of  several  of  the  actions 
which  take  place  in  this  disease  of  the  stomach, 
with  those  which  take  placejn  the  brain  in  mad- 
ness, and  from  the  sameness  of  the  ordinary  dura- 
tion of  a  paroxysm  of  each  of  them,  I  have  called 
the  former,  derangement  in  the  stomach. 

The  longer  the  intervals  between  the  paroxysms 
of  madness,  the  more  complete  is  the  restoration 
of  reason.  Remissions,  rather  than  intermissions 
take  place  when  the  intervals  are  of  short  dura- 
tion, and  these  distinguish  it  from  febrile  delirium, 
in  which  intermissions  more  generally  occur.  In 
many  cases,  every  thing  is  remembered  that  passes 
under  the  notice  of  the  patient  during  a  paroxysm 


OP  THE  MIND.  1G3 

of  general  madness,  but  in  those  cases  in  which 
the  memory  is  diseased,  as  well  as  the  understand- 
ing, nothing  is  recollected.     I  attended  a  lady,  in 
the  month  of  October  1802,  who  had  crossed  the 
Atlantic  ocean  during  a  paroxysm   of  derange- 
ment, without  recollecting  a  single  circumstance 
of  her  voyage,  any  more  than  if  she  had  passed 
the  whole  time  in  sleep.     Sometimes  every  thing 
is  forgotten   in  the  interval  of  a  paroxysm,  but 
recollected  in   a  succeeding  paroxysm.     I  once 
attended  the  daughter  of  a  British  officer,  who  had 
been  educated  in  the  habits  of  gay  life,  who  was 
married  to  a  methodist  minister.     In  her  parox- 
ysms  of  madness   she  resumed  her  gay  habits, 
spoke  French,  and  ridiculed  the  tenets  and  prac- 
tices of  the  sect  to  which  she  belonged.     In  the 
intervals  of  her  fits  she  renounced  her  gay  habits, 
became  zealously  devoted  to  the  religious  princi- 
ples and  ceremonies  of  the  Methodists,  and  forgot 
every  thing  she  did  and  said  during  the  fits  of  her 
insanity.     A  deranged  sailor,  some  years  ago  in 
the  Pennsylvania  Hospital,  fancied  himself  to  be 
an  admiral,  and  walked  and  commanded  with  all 
the  dignity  and  authority  that  are  connected  with 
that  high  rank  in  the  navy.     He  was  cured  and 
discharged ;  his   disease   some   time   afterwards 
returned,  and  with  it  all  the  actions  of  an  admiral 
which   he  assumed   and   imitated  in  his  former 


164  ON  THE  DISEASES 

paroxysm.  It  is  remarkable,  some  persons  when 
deranged  talk  rationally,  but  act  irrationally,  .while 
others  act  rationally  and  talk  irrationally.  We 
had  a  sailor  some  years  ago  in  our  hospital,  who 
spent  a  whole  year  in  building  and  rigging  a  small 
ship  in  his  cell.  Every  part  of  it  was  formed  by 
a  mind  apparently  in  a  sound  state.  During  the 
whole  of  the  year  in  which  he  was  employed  in 
this  work,  he  spoke  not  a  word.  In  bringing  his 
ship  out  of  his  cell,  a  part  of  it  was  broken.  He 
immediately  spoke,  and  became  violently  de- 
ranged soon  afterwards.  Again,  some  madmen 
talk  rationally,  and  write  irrationally;  but  it  is 
more  common  for  them  to  utter  a  few  connected 
sentences  in  conversation,  but  not  to  be  able  to 
connect  two  correct  sentences  together  in  a  let- 
ter. Of  this  I  have  known  many  instances  in  our 
hospital. 

V.  Mania  is  sometimes  combined  with  phreni- 
tis.  The  brain,  in  this  case,  is  in  the  same  state 
as  the  lungs,  when  an  acute  pneumony  blends  it- 
self with  a  pulmonary  consumption.  Excitement 
in  both  cases  is  abstracted  from  the  muscles,  so 
that  the  patients  are  usually  confined  to  their 
beds.  The  tongue  is  more  furred,  and  the  skin 
much  warmer,  in  this  mixture  of  mania  and  phre- 
nitis,  than  in  madness  alone.  It  occurs  most  fre- 


OP  THE  MIND.  165 

quently  after  parturition.  I  have  taken  the  liberty 
of  caljing  it  Phrenimania. 

VI.  Mania  is  sometimes  combined  with  the 
burning,  sweating,  cold,  chilly  intermitting,  and 
even  hydrophobic  states  of  fever.  Instances  of 
them  were  mentioned  in  treating  upon  the  seat 
and  proximate  cause  of  madness.  A  case  of  its 
union  with  hydrophobia  occurred  in  a  lady  under 
my  care  in  the  month  of  February  1812.  She 
attempted  several  times  to  bite  her  attendants, 
and  was  greatly  agitated  when  the  word  "  water" 
was  mentioned  in  her  room.  As  the  pulse  in  this 
mixture  of  mania  and  common  fever  is  generally 
synochus,  I  have  called  it  Syfiocomania. . 

In  all  the  forms  and  combinations  of  madness 
that  have  been  described,  the  duration  of  the  dis- 
ease, after  it  is  completely  formed,  seems  to  be  as 
much  fixed  by  nature  as  the  duration  of  an  au- 
tumnal fever.  It  may  be  weakened,  and  life  may 
be  preserved  during  its  continuance,  but,  unless  it 
be  overcome  in  its  first  stage,  it  generally  runs  its 
course,  in  spite  of  all  the  power  of  medicine. 

VII.  There  is  a  form  of  mania  which  is  seldom 
the  object  of  medical  attention,  either  in  hospitals, 


166  ON  THE  DISEASES 

or  in  private  practice,  but  which  is  well  known, 
not  only  to  physicians,  but  to  persons  of  common 
observation  in  every  part  of  the  world.  Dr.  Cox 
has  described  it  very  happily  and  correctly  in  the 
following  words. 

"  Among  the  varieties  of  maniacs  met  with  in 
medical  practice,  there  is  one,  which,  though  by 
no  means  rare,  has  been  little  noticed  by  writers 
on  this  subject :  I  refer  to  those  cases,  in  which 
the  individuals  perform  most  of  the  common  du- 
ties of  life  with  propriety,  and  some  of  them,  in- 
deed, with  scrupulous  exactness,  who  exhibit  no 
strongly  marked  features  of  either  temperament, 
no  traits  of  superior  or  defective  mental  endow- 
ment, but  yet  take  violent  antipathies,  harbour 
unjust  suspicions,  indulge  strong  propensities, 
affect  singularity  in  dress,  gait,  and  phraseology ; 
are  proud,  conceited,  and  ostentatious ;  easily 
excited,  and  with  difficulty  appeased ;  dead  to 
sensibility,  delicacy,  and  refinement ;  obstinately 
riveted  to  the  most  absurd  opinions ;  prone  to 
controversy,  and  yet  incapable  of  reasoning; 
always  the  hero  of  their  own  tale,  using  hyper- 
bolic highflown  language  to  express  the  most 
simple  ideas,  accompanied  by  unnatural  gesticu- 
lation, inordinate  action,  and  frequently  by  the 


OP  THE  MIND.  167 

most  alarming  expression  of  countenance.  On 
some  occasions  they  suspect  similar  intentions  on 
the  most  trivial  grounds,  on  others  are  a  prey  to 
fear  and  dread  from  the  most  ridiculous  and  im- 
aginary sources ;  now  embracing  every  opportu- 
nity of  exhibiting  romantic  courage  and  feats  of 
hardidood,  then  indulging  themselves  in  all  man- 
ner of  excesses. 

"Persons  of  this  description,  to  the  casual  ob- 
server, might  appear  actuated  by  a  bad  heart,  but 
the  experienced  physician  knows  it  is  the  head 
which  is  defective.     They  seem  as  if  constantly 
affected  by  a  greater  or  less  degree  of  stimulation 
from  intoxicating  liquors,  while  the  expression  of 
countenance  furnishes  an  infallible  proof  of  men- 
tal disease.     If  subjected  to  moral  restraint,  or  a 
medical  regimen,  they  yield  with  reluctance  to 
the   m-eans   proposed,   and  generally  refuse  and 
resist,  on  the  ground  that  such  means  are  unne- 
cessary where  no  disease  exists  ;  and  when,  by  the 
system  adopted,  they  are  so  far  recovered,  as  to 
be   enabled   to   suppress   the   exhibition   of   the 
former   peculiarities,   and   are   again    fit    to   be 
restored   to   society,    the    physician,   and   those 
friends  who  put  them  under  the  physician's  care, 
are,  generally,  ever  after  objects  of  enmity  and 
frequently  of  revenge." 


168  ON  THE  DISEASES 

VIII.  There  is  a  form  of  madness  which  is 
altogether  internal,  and  of  which  I  have  met  with 
several  instances.  It  consists  in  the  same  kind 
of  alienation  of  mind  that  takes  place  in  common 
madness,  but  which  is  subject  to  the  command 
of  the  will ;  persons  affected  with  it  feel  all  the 
distraction  of  thoughts  and  anguish  of  madness 
when  alone,  and  sometimes  in  company,  when 
they  are  silent,  or  inattentive  to  conversation,  but 
without  discovering  any  of  its  signs  in  their 
countenances  or  behavour.  It  resembles,  in  this 
respect,  that  feeble  grade  of  the  delirium  of  a 
fever,  which  is  chased  away  by  the  visit  of  a  phy- 
sician, or  by  speaking  to  the  patient  upon  any  inte- 
resting subject.  I  have  suspected  the  cases  of 
suicide,  which  sometimes  occur  in  persons  appa- 
rently in  a  sound  state  of  mind,  are  occasioned  by 
this  form  of  madness.  They  may  be  compared, 
in  this  situation,  to  patients  in  the  walking  state 
of  the  yellow  fever,  in  whom  all  the  sympathies  of 
the  body  are  destroyed,  in  consequence  of  which 
its  external  parts  appear  sound  and  healthy,  while 
the  stomach,  and  other  vital  parts  are  perishing 
by  disease.  I  have  called  this  internal  form  of 
madness  mania  larvata. 

There  has  been  a  diversity  of  opinions  respect- 
ing the  influence  of  the  moon  inducing,  or  in- 


OF  THE  MIND.  169 

creasing,  paroxysms  of  madness,  after  it    has 
taken  possession  of  the  system.    The  late  Dr. 
James  Hutchinson,  who  spent  several  years  in  the 
Pennsylvania  Hospital  as  its  resident  physician 
and  apothecary,  assured  me,  that  he  had  never 
seen  the  least  change  in  the  disease  of  the  ma- 
niacs from  the  state  of  the  moon.    Mr.  Halsam 
tells  us,  that  in  two  years  close  attention  to  the 
state  of  the  maniacs  in  Bethlehem  Hospital,  in 
London,  he  had  never  seen  their  disease  increase 
at  the  lunar  periods.    To  these  facts  is  opposed 
the  testimony  of  ages,  in  all  countries.    There  is, 
I  believe,  an  equal  portion  of  truth  on  the  side  of 
both  these  opinions.    In  order  to  reconcile  them, 
it  will  be  proper  to  remark,  1st,  that  in  certain 
diseases  and  in  certain  debilitated  states  of  the 
system,  the  body  acquires  a  kind  of  sixth  sense, 
that  is,  a  perception  of  heat  and  cold,  of  moisture 
and  dryness,  of  the  density  and  rarity  of  the  air, 
and  of  light  and  darkness,  of  which  it  is  insensible 
in  a  healthy  state.     2,  The  moon,  when  full,  in- 
creases the  rarity  of  the  air  and  the  quantity  of 
light,  each  of  which,  I  believe,  acts  upon  sick 
people  in  various  diseases,  and,  among  others,  in 
madness.     A  predisposition  to  the  action  of  such 
feeble  causes  is  required  in  all  cases.     From  the 
conversion    of  excitability    into    excitement    in 
mania,  and  from  its  absence  in  manalgia,  it  is 


*&J 

22 


170  ON  THE  DISEASES 

easy  to  conceive,  in  both  those  states  of  derange- 
ment, the  system  will  be  insensible  to  the  influ- 
ence of  the  moon.  Now  when  we  consider  that 
a  great  majority  of  the  patients  in  most  hospitals 
are  in  one  of  those  states  of  madness,  it  is  easy  to 
account  for  their  exhibiting  no  marks  of  lunar  in- 
fluence, according  to  the  observations  of  Dr. 
Hutchinson  and  Mr.  Halsam.  In  the  year  1807, 
I  requested  Mr.  Thornton,  then  one  of  the  apothe- 
caries of  the  hospital,  to  attend  particularly  to 
the  influence  of  the  morning  light  upon  all  the 
maniacal  patients  that  were  at  the  time  confined 
in  it.  He  informed  me,  that  many  of  them  be- 
came noisy  as  soon  as  the  day  began  to  break, 
and  that,  with  the  exception  of  two  or  three  re- 
cent cases,  they  all  became  silent  and  quiet  after 
night.  During  the  eclipse  of  the  sun  on  the  16th 
of  June,  1806,  there  was  a  sudden  and  total 
silence  in  all  the  cells  of  the  hospital. 

The  inference  from  these  facts  is,  that  the 
cases  are  few  in  which  mad  people  feel  the  influ- 
ence of  the  moon,  and  that  when  they  do,  it  is 
derived  chiefly  from  an  increase  of  its  light.  It 
is  possible  the  absence  of  its  light  may  be  attend- 
ed with  equal  commotions  in  the  system  of  pa- 
tients who  are  afflicted  with  that  form  of  derange- 
ment which  I  have  called  tristimania. 


OP  THE  MIND.  171 

It  is  possible,  further,  that  in  the  few  cases  in 
which  the  light  of  the  moon  or  the  rarity  of  the 
air,  is  felt  by  deranged  persons  in  a  hospital,  that 
their  noise,  by  keeping  a  number  of  patients  in 
neighbouring  cells  awake,  and  in  a  state  of  in- 
quietude from  the  want  of  sleep,  may  have  con- 
tributed to  establish  that  general  belief  in  the 
influence  of  the  moon  upon  madness,  which  has 
so  long  obtained  among  physicians. 


172  ON  THE  DISEASES 


CHAPTER  VII. 

Of  the  Remedies  of  Mania. 

BEFORE  we  proceed  to  mention  the  remedies 
for  mania,  or  the  highest  grade  of  general  mad- 
ness, it  will  be  necessary  to  mention  the  means 
of  establishing  a  complete  government  over  pa- 
tients afflicted  with  it,  and  thus,  by  securing  their 
obedience,  respect,  and  affections,  to  enable  a 
physician  to  apply  his  remedies  with  ease,  cer- 
tainty and  success. 

The  first  thing  to  be  done,  to  accomplish  these 
purposes,  is  to  remove  the  patient  from  his  family, 
and  from  the  society  of  persons  whom  he  has 
been  accustomed  to  command,  to  a  place  where 
he  will  be  prevented  from  injuring  himself  and 
others. — If  there  be  objections  to  removing  him 
to  a  public  or  private  mad-house,  or  if  this  be  im- 
practicable, the  patient  should  be  confined  in  a 
chamber,  in  which  he  has  not  been  accustomed 


OP  THE  MIND.  173 

to  sleep,  and  a  stranger  or  strangers  should  be 
employed  exclusively  to  attend  him.  The  effect 
of  thus  depriving  a  madman  of  his  liberty,  has 
sometimes  been  of  the  most  salutary  nature,  by 
suddenly  creating  a  new  current  of  ideas,  as  well 
as  by  the  depression  it  produces  in  his  mind. 

1.  This  preliminary  measure  being  taken,  the 
first  object  of  a  physician,  when  he  enters  the  cell 
or  chamber  of  his  deranged  patient,  should  be,  to 
catch  his  EYE,  and  look  him  out  of  countenance. 
The  dread  of  the  eye  was  early  imposed  upon 
every  beast  of  the  field.  The  tiger,  the  mad  bull, 
and  the  enraged  dog,  all  fly  from  it;  now  a  man 
deprived  of  his  reason,  partakes  so  much  of  the 
nature  of  those  animals,  that  he  is  for  the  most 
part  easily  terrified,  or  composed,  by  the  eye  of  a 
man  who  possesses  his  reason.  I  know  this  do- 
minion of  the  eye  over  mad  people,  is  denied  by 
Mr.  Halsam,  from  his  supposing  that  it  consists 
simply  in  imparting  to  the  eye  a  stern  or  ferocious 
look.  This  may  sometimes  be  necessary ;  but  a 
much  greater  effect  is  produced,  by  looking  the 
patient  out  of  countenance  with  a  mild  and  stea- 
dy eye,  and  varying  its  aspect  from  the  highest 
degree  of  sternness,  down  to  the  mildest  degree 
of  benignity;  for  there  are  keys  in  the  eye,  if  I 
may  be  allowed  the  expression,  which  should  be 


174  ON  THE  DISEASES 

suited  to  the  state  of  the  patient's  mind,  with  the 
same  exactness  that  musical  tones  should  be  suit- 
ed to  the  depression  of  spirits  in  hypochondriasis. 
— Mr.  Halsam  again  asks,  "  Where  is  the  man 
that  would  trust  himself  alone  with  a  madman, 
with  no  other  means  of  subduing  him  than  by  his 
eye?"  This  may  be,  and  yet  the  efficacy  of  the 
eye  as  a  calming  remedy  not  be  called  in  ques- 
tion. It  is  but  one  of  several  other  remedies  that 
are  proper  to  tranquilize  him,  and  when  used 
alone,  may  not  be  sufficient  for  that  purpose. 
Who  will  deny  the  efficacy  of  bleeding  for  the 
cure  of  madness?  and  yet  who  would  rely  upon  it 
exclusively,  without  the  aid  of  other  remedies? 
In  favour  of  the  power  of  the  eye,  in  conjunction 
with  other  means  in  composing  mad  people,  I 
1  can  speak  from  the  experience  of  many  years. 
It  has  been  witnessed  by  several  hundred  students 
of  medicine  in  our  hospital,  and  once  by  several 
of  the  managers  of  the  hospital,  in  the  case  of  a 
man  recently  brought  into  their  room,  and  whose 
conduct  for  a  considerable  time  resisted  its  effi- 
cacy. 

2.  A  second  means  of  securing  the  obedience 
of  a  deranged  patient  to  a  physician,  should  be 
by  his  VOICE.  Milton  calls  the  human  face  "  di- 
vine." It  would  be  more  proper  to  apply  that 


OP  THE  MIND.  175 

epithet  to  the  human  voice,  from  its  wonderful 
effects  upon  the  mind  of  man,  whether  employed 
in  simple  tones,  in  music,  or  in  speech.  Even 
brutes  feel  and  obey  it.  In  governing  mad  peo- 
ple, it  should  be  harsh,  gentle,  or  plaintive,  ac- 
cording to  circumstances.  I  have  observed,  with 
great  pleasure,  the  most  beneficial  effects  pro- 
duced by  it  in  all  those  ways.  A  patient  in  the 
Pennsylvania  Hospital,  who  called  his  physician 
his  father,  once  lifted  his  hand  to  strike  him. 
"  What!"  said  his  physician,  with  a  plaintive  tone 
of  voice,  "  strike  your  father !"  The  madman 
dropped  his  arm,  and  instantly  showed  marks  of 
contrition  for  his  conduct. 

In  Java,  madness  of  a  furious  kind  is  often 
brought  on  by  the  intemperate  use  of  opium. 
The  poor,  when  affected  with  it,  are  put  to  death; 
but  the  rich,  who  are  able  to  purchase  the  ser- 
vices of  female  nurses,  generally  recover.  May 
not  their  recovery  be  ascribed,  in  part,  to  their 
ears  being  constantly  exposed  to  the  gentleness 
and  softness  of  a  female  voice  ? 

3.  The  COUNTENANCE  of  a  physician  should 
assist  his  eye  and  voice  in  governing  his  de- 
ranged patients.  It  should  be  accommodated  to 
the  state  of  the  patient's  mind  and  conduct.  There 


176  ON  THE  DISEASES 

is  something  like  contagion  in  the  different  as- 
pects of  the  human  face,  and  madmen  feel  it  in 
common  with  other  people.  A  grave  counten- 
ance in  a  physician  has  often  checked  the  frothy 
levity  of  a  deranged  patient  in  an  instant,  and  a 
placid  one  has  as  suddenly  chased  away  his 
gloom.  A  stern  countenance  in  like  manner  has 
often  put  a  stop  to  garrulity,  and  a  cheerful  one 
has  extorted  smiles  even  from  the  face  of  melan- 
choly itself. 

4.  The  CONDUCT  of  a  physician  to  his  patients 
should  be  uniformly  dignified,  if  he  wishes  to  ac- 
quire their  obedience  and  respect.     He  should 
never  descend  to  levity  in  conversing  with  them. 
He  should  hear  with  silence  their  rude  or  witty 
answers  to  his  questions,  and  upon  no  account 
ever  laugh  at  them,  or  with  them. 

5.  ACTS  of  justice,  and  a  strict  regard  to  truth, 
tend  to  secure  the  respect  and  obedience  of  de- 
ranged patients  to  their  physician.     Every  thing 
necessary  for  their  comfort  should  be  provided 
for  them,  and  every  promise  made  to  them  should 
be  faithfully  and  punctually  performed.     I  once 
lost  the  confidence  of  a  maniac,  by  simply  failing 
to  enlarge  him  on  an  appointed  day,  in  conse- 
quence of  an  unexpected  revival  of  some  of  the 
symptoms  of  his  disease. 


OF  THE  MIND.  177 

6,  A  physician  should  treat  his  deranged  pa- 
tients with  respect,  and  with  all  the  ceremonies 
which  are  due  to  their  former  rank  and  habits  of 
living.     Carpets  upon  the  floors  of  their  rooms  or 
cells,  curtains  to  their  beds,  taste  in  the  prepara- 
tion and  manner  of  serving  their' meals,  will  all 
serve  to  prevent  distress  and  irritation,  from  a 
supposed  change  in   their  condition  in  life.     I 
have  known  a  deranged  gentleman  complain  of 
being  addressed  without  the  title  of  Mr.;  and  I 
have  seen  several  others  turn  with  an  indignant 
look  from  their  food,  when  served  to  them  upon 
a  table  not  covered  with  a  cloth,  or  in  vessels 
they  had  not  been  accustomed  to  in  their  own 
families.     With  this  habitual  attachment  to  forms 
in  behaviour,  and  taste  in  living,  there  is  in  this 
class  of  patients   a  similar  respect  for  former 
habits  of  society,  for  which  reason  they  should 
always  eat,  sit,  and  partake  of  amusements,  by 
themselves.     The  great  advantage  which  private 
madhouses  have  over  public  hospitals,  is  derived 
chiefly  from  their  conforming  to  this  principle  in 
human  nature;  which  the  highest  grade  of  mad- 

o  o 

ness  is  seldom  able  to  eradicate. 

7.  And  lastly.     A  physician  acquires  the  obe- 
dience and  affections  of  his  deranged  patients  by 
ACTS  of  KINDNESS.     For  this  purpose,  all  his  di- 

23 


178  ON  THE  DISEASES 

rections  for  discontinuing  painful  or  disagreeable 
remedies,  and  all  his  pleasant  prescriptions, 
should  be  delivered  in  the  presence  of  his  pa- 
tients ;  while  such  as  are  of  an  unpleasant  nature, 
should  be  delivered  only  to  their  keepers.  Small 
presents  of  fruit  or  sweet-cake,  will  have  a  happy 
effect  in  attaching  maniacal  patients  to  their  phy- 
sicians, for  it  is  a  fact,  that  in  proportion  to  the 
intensity  of  misery,  the  subjects  of  it  feel  most 
sensibly  the  smallest  diminution  of  it.  Perhaps 
the  recovery  of  the  madmen  in  Java,  just  now 
mentioned,  may  be  ascribed,  further,  to  their  being 
nursed  by  women,  in  whom  kindness  to  the  sick 
and  distressed  is  so  universal,  that  it  forms  an  es- 
sential and  predominating  feature  in  the  female 
character. 

As  an  inducement  to  treat  mad  people  in  the 
manner  that  has  been  recommended,  I  shall  only 
add,  that  in  those  cases  in  which  the  memory  has 
been  greatly  impaired,  they  seldom  forget  three 
things  after  their  recovery,  viz.  acts  of  cruelty, 
acts  of  indignity,  and  acts  of  kindness.  1  have 
known  instances  in  which  the  two  former  have 
been  recollected  by  them  with  painful,  and  the  :t 
last  with  pleasant  associations  for  many  years. 

In  gratitude  for  kindness  and  favours  shown  to 
them,  they  exceed  all  other  classes  of  patients 


OF  THE  MIND.  179 

after  their  recovery.  A  physician  once  asked  a 
young  woman  of  the  society  of  Friends,  whom  he 
had  assisted  in  curing  in  the  Pennsylvania  Hos- 
pital, if  she  had  forgiven  him  for  compelling  her 
to  submit  to  the  remedies  that  had  been  employed 
for  that  purpose.  "  Forgive  thee !"  said  she, 
"  why  I  love  the  very  ground  thou  walkest  on." 

If  all  the  means  that  have  been  mentioned 
should  prove  ineffectual  to  establish  a  govern- 
ment over  deranged  patients,  recourse  should  be 
had  to  certain  modes  of  coercion.  These  will 
sometimes  be  necessary  in  order  to  prevent  their 
destroying  their  clothes  and  the  furniture  of  their 
cells,  as  well  as  to  punish  outrages  upon  their 
keepers  and  upon  each  other.  The  following 
means  will  generally  be  found  sufficient  for  these 
purposes. 

1.  Confinement  by  means  of  a  strait  waistcoat, 
or  of  a  chair,  which  I  have  called  a  tranquillzer. 
— He  submits  to  them  both  with  less  difficulty 
than  to  human  force,  and  struggles  less  to  disen- 
gage himself  from  them.  The  tranquilizer  has 
several  advantages  over  the  strait  waistcoat  or 
mad  shirt. — It  opposes  the  impetus  of  the  blood 
towards  the  brain,  it  lessens  muscular  action 
every  where,  it  reduces  the  force  and  frequency 


180  ON  THE  DISEASES 

of  the  pulse,  it  favours  the  application  of  cold 
water  and  ice  to  the  head,  and  warm  water  to  the 
feet,  both  of  which,  I  shall  say  presently,  are  ex- 
cellent remedies  in  this  disease;  it  enables  the 
physician  to  feel  the  pulse  and  to  bleed  without 
any  trouble,  or  altering  the  erect  position  of  the 
patient's  body;  and,  lastly,  it  relieves  him,  by 
means  of  a  close  stool,  half  filled  with  water,  over 
which  he  constantly  sits,  from  the  fcetor  and  filth 
of  his  alvine  evacuations.* 

2.  Privation  of  their  customary  pleasant  food. 

3.  Pouring  cold  water  under  the  coat  sleeves, 
so  that  it  may  descend  into  the  arm  pits,  and 
down  the  trunk  of  the  body. 

4.  The  shower  bath,  continued  for  fifteen  or 
twenty  minutes.     If  all  these  modes  of  punish- 
ment should  fail  of  their  intended  effects,  it  will 
be  proper  to  resort  to  the  fear  of  death.     Mr. 
Higgins  proved  the  efficacy  of  this  fear,  in  com- 
pletely subduing  a  certain  Sarah  T ,  whose 

profane  and  indecent  conversation  and  loud  vo- 
ciferations, offended  and  disturbed  the  whole  hos- 

*  A  chair,  such  as  has  been  described,  may  be  seen  in  the 
Pennsylvania  Hospital,  and  an  engraving  of  it  in  the  last  volume 
of  Dr.  Coxe's  Medical  Museum. 


OF  THE  MIND.  181 

pital.  He  had  attempted  in  vain  by  light  punish- 
ments and  threats,  to  put  a  stop  to  them.  At 
length  he  went  to  her  cell,  from  whence  he  con- 
ducted her,  cursing  and  swearing  as  usual,  to  a 
large  bathing  tub,  in  which  he  placed  her.  "  Now, 
(said  he)  prepare  for  death.  I  will  give  you  time 
enough  to  say  your  prayers,  after  which  I  intend 
to  drown  you,  by  plunging  your  head  under  this 
water."  She  immediately  uttered  a  prayer,  such 
as  became  a  dying  person.  Upon  discovering 
this  sign  of  penitence,  Mr.  Higgins  obtained  from 
her  a  promise  of  amendment.  From  that  time  no 
profane  or  indecent  language,  nor  noises  of  any 
kind,  were  heard  in  her  cell. 

By  the  proper  application  of  these  mild  and 
terrifying  modes  of  punishment,  chains  will  sel- 
dom, and  the  whip  never,  be  required  to  govern 
mad  people.  I  except  only  from  the  use  of  the 
latter,  those  cases  in  which  a  sudden  and  unpro- 
voked assault  of  their  physicians  or  keepers  may 
render  a  stroke  or  two  of  a  whip,  or  of  the  hand, 
a  necessary  measure  of  self-defence. 

To  encourage  us  in  the  use  of  all  the  means 
that  have  been  mentioned  for  subduing  the  tem- 
pers of  mad  people,  and  acquiring  a  complete 
government  over  them,  I  shall  only  add  to  the 


182  ON  THE  DISEASES 

history  I  have  given  of  their  disease,  that  there  is 
a  predisposition  in  their  minds  to  be  acted  upon 
by  them,  founded  in  their  timidity.  They  are 
not  only  afraid  of  their  keepers  and  attendants, 
but  of  one  another.  Some  years  ago,  a  madman 
of  the  name  of  Hoops,  disturbed  the  whole  vil- 
lage of  Chester,  in  this  state,  by  his  conduct.  A 
person  more  rnad  than  himself,  came  into  the 
town.  Hoops  instantly  ran  from  him,  and  took 
shelter  in  the  court  house  while  the  court  was 
sitting.  There  was  an  instance  of  the  same  ti- 
midity in  a  madman  in  our  hospital,  in  the  month 
of  February,  1810.  In  consequence  of  the  house 
being  unusually  crowded  with  mad  people,  two 
men  were  confined  in  one  cell.  One  of  them,  who 
was  very  noisy,  was  instantly  silenced  by  the  re- 
bukes of  his  less  deranged  companion.  He  even 
crept  into  the  corner  of  a  cell  to  avoid  him. 

The  remedies  for  general  mania  next  come 
under  our  consideration.  In  enumerating  them, 
I  shall  adopt  the  same  order  that  I  followed  in 
treating  upon  partial  insanity,  by  mentioning, 

I.  Such  as  should  be  applied  to  the  mind, 
through  the  medium  of  the  body ;  and, 


OF  THE  MIND.  183 

II.  Such  as  should  be  applied  to  the  body, 
through  the  medium  of  the  mind.  *y  v 

I.  The  first  remedy  under  this  head,  should  be 
blood-letting. 

This  evacuation  is  indicated, 

1.  By  all  the  facts  and  arguments  formerly 
mentioned,  in  favour  of  this  grade  of  madnes% 
being  an  arterial  disease,  of  great  morbid  excite- 
ment or  inflammation  in  the  brain,  particularly 
by  the  state  of  the  pulse,  and,  when  this  is  natu- 
ral, by  the  state  of  the  countenance,  by  wakeful- 
ness,  and  by  a  noisy  and  talkative  disposition. 

2.  By  the  appetite  being  uninterrupted,  and 
often  unrestrained,  whereby  the  blood-vessels  be- 
come overcharged  with  blood. 

3.  By  the  importance  and  delicate  structure  of 
the  brain,  which  forbid  its  bearing  violent  morbid 
action  for  a  length  of  time,  without  undergoing 
permanent  obstruction  or  disorganization.     The 
danger  from  this   cause  is  much  increased  by 
the  wakefulness,  hollowing,  singing,  and  strong 
muscular  exertions  of  persons  in  this  state  of 
madness. 


184  ON  THE  DISEASES 

4.  By  there  being  no  outlet  from  the  brain,  in 
common  with  other  viscera,  to  receive  the  usual 
results  of  disease  or  inflammation,  particularly 
the  discharge  of  serum  from  the  blood-vessels. 

5.  By  the  accidental  cures  which  have  followed 
the  loss  of  large  quantities  of  blood.     Many  mad 
people,  who  have  attempted  to  destroy  themselves 
by  cutting  their  throats,  or  otherwise  opening 

Jarge  blood-vessels,  have  been  cured  by  the  pro- 
fuse haemorrhages  which  have  succeeded  those 
acts.  Of  this,  several  instances  have  occurred 
within  my  knowledge. 

6.  By  the  morbid  appearances  of  the  blood 
which  has  been  drawn  for  the  cure  of  this  form 
of  madness.     It  is  generally  diseased  beyond  that 
grade  in  which  it  exhibits  a  buffy  coat.     Of  200 
patients  bled  by  Mr.  Halsam,  in  the  Bethlehem 
Hospital,  the  blood  was  sizy  in  but  six  cases,  and 
from  the  cause  that  has  been  assigned.     I  have 
seen  nearly  all  the  morbid  appearances  of  the 
blood  which  I  have  enumerated  in  my  defence  of 
blood-letting,  and  never  a  single  instance  in  which 
it  put  on  a  natural  appearance. 

7.  Blood-letting  is  indicated  by  the  extraordi- 
nary success  which  has  attended  its  artificial  use 


OF  THE  MIND.  185 

in  the  United  States,  and  particularly  in  the  Penn- 
sylvania Hospital. 

In  the  use  of  bleeding  in  this  state  of  madness, 
the  following  rules  should  be  observed:  . 

1.  It  should  be  copious  on  the  first  attack 
of  the  disease.  From  20  to  40  ounces  of  blood 
may  be  taken  at  once,  unless  fainting  be  induced 
before  that  quantity  be  drawn.  It  will  do  most 
service  if  the  patient  be  bled  in  a  standing  pos- 
ture. The  effects  of  this  early  and  copious 
bleeding  are  wonderful  in  calming  mad  people. 
It  often  prevents  the  necessity  of  using  any 
other  remedy,  and  sometimes  it  cures  in  a  few 
hours. 

2.  It  should  be  continued  not  only  while  any 
of  those  states  of  morbid  action  in  the  pulse  re- 
main which  require  bleeding  in  other  diseases, 
but  in  the  absence  of  them  all,  provided  great 
wakefulness,  redness  in  the  eyes,  a  ferocious 
countenance,  and  noisy  and  refractory  behaviour 
continue,  all  of  which  indicate  a  highly  morbid 
state  of  the  brain.  We  bleed  in  the  same 
natural  state  of  the  pulse  in  the  pneumonia 
notha.  We  do  the  same  thing  in  a  similar  form 
of  hepatitis. 

24 


186  ON  THE  DISEASES 

The  propriety  of  bleeding  in  this  mania  notha, 
if  I  may  be  allowed  to  use  a  term  founded  upon 
the  unity  of  its  cause  (that  is,  congestion  of  blood 
without  inflammation)  with  the  causes  of  the 
above  diseases  of  the  lungs  and  liver,  has  often 
been  demonstrated  in  the  Pennsylvania  Hospital. 
Its  advantages,  I  well  recollect,  attracted  the  at- 
tention of  the  pupils  of  the  hospital  in  the  year 
1805,  in  a  more  than  ordinary  manner,  in  the 
case  of  a  man  of  the  name  of  Pickins.  His  mad- 
ness was  recent,  his  skin  was  cool,  and  his  pulse 
natural,  but  his  eyes  suffused  with  blood,  and  he 
was  unable  to  sleep.  1  bled  him  copiously,  after 
which  his  pulse  became  frequent  and  tense.  I 
repeated  the  bleeding,  and  gave  him  several 
doses  of  purging  physic,  which  cured  him  in  a 
few  days. 

3.  It  should  be  more  copious  in  phrenimania 
and  synochomania,  than  in  simple  madness.    Its 
liberal  use  is  particularly  indicated  in  the  latter, 
when  it  is  formed  by  the  union  of  madness  with 
pregnancy,  or  with  the  autumnal  or  puerperal 
fever,  in  all  which  the  blood-vessels  labour  un- 
der disease  in  other  parts  of  the  body,  as  well  as 
the  brain. 

4.  It  should  be  less  copious  in  madness  from 


OF  THE  MIND.  1  87 

drunkenness,  than  from  any  of  its  other  causes, 
all  the  circumstances  that  call  for  it  being  equal. 
For  the  reasons  for  this  caution,  the  reader  will 
please  to  consult  the  defence  of  blood-letting,  in 
the  third  volume  of  the  author's  Medical  Inquiries 
and  Observations. 

5.  It  is  indicated  no  less  in  the  seventh  and 
eighth  forms  of  general  mania,  formerly  described, 
than  in  those  which  preceded  them.     I  think  I 
once  prevented  suicide  by  it,  in  a  young  gentle- 
man descended  from  a  family  in  which  several  of 
its  members  had  perished  by  their  own  hands. 

6.  The   quantity   of  blood  drawn,  should  be 
greater  than  in  any  other  organic  disease.     This 
is  indicated  not  only  by  most  of  the  reasons  for 
bleeding  formerly  given,  but  by  the  strong  and 
uncommon  hold  which  the  disease  takes  of  the 
brain.     Many  circumstances  prove  this  to  be  the 
case,  but  none  more  than  its  not  being  cured,  and 
scarcely  suspended,  by  the  acute  and  painful  dis- 
ease  of  parturition,  several  instances  of  which 
have  come  under  my  notice.     From  among  many 
cases  of  the  successful  issue  of  profuse  bleeding 
in  this  form  of  madness,  I  shall  select  but  two: 
the  former  was  in  Mr.  T.  H.  of  the  state  of  New 
Jersey,  a  man  of  sixty-eight  years  of  age,  from 


8  ON  THE  DISEASES 


whom  I  drew  nearly  200  ounces  of  blood,  between 
the  20th  of  December  and  the  14th  of  February, 
in  the  year  1 807 ;  the  latter  was  in  Mr.  D.  T.  of 
the  state  of  New  York,  who  lost  about  470 
ounces,  by  my  order,  by  47  bleedings,  between 
the  months  of  June  1810,  and  April  1811.  Both 
these  gentlemen  were  my  private  patients  in  the 
Pennsylvania  Hospital.  Were  it  necessary,  I 
could  add  to  these  cases  several  others,  commu- 
nicated to  me  by  my  pupils,  particularly  by  Dr. 
Wallace,  of  Virginia,  and  Dr.  Anan,  of  Maryland, 
in  which  a  similar  practice  had  been  attended 
with  the  same  success. 

After  all  the  symptoms  which  "ball  for  blood- 
letting have  disappeared,  we  sometimes  observe 
the  disease  to  continue.  In  this  case,  morbid  ex- 
citement becomes  insolated,  but  still  so  considera- 
ble as  not  to  yield  to  purges  or  blisters.  Here, 
CUPPING  is  indicated.  The  cups  should  be  ap- 
plied to  the  temples,  behind  the  ears,  and  to  the 
nape  of  the  neck.  Leeches  may  be  used  for  the 
same  purpose,  and  to  the  same  places.  They 
may  likewise  be  applied  to  the  haemorrhoidal  ves- 
sels with  advantage,  in  persons  who  have  been 
subject  to  the  piles.  The  sympathy  of  the  brain 
with  these  vessels  is  so  intimate,  that  the  disease 
yields  as  readily  to  the  loss  of  blood  from  them, 


OF  THE  MIND.  189 

as  from  the  parts  that  have  been  mentioned  near 
the  brain. 

Arteriotomy  performed  upon  the  temporal  ar- 
tery, it  is  said,  is  more  useful  than  venesection, 
or  local  bleeding  with  cups  and  leeches.  I  can 
say  nothing  in  its  favour  from  my  own  experience. 

I  have  only  to  add  to  these  remarks  upon  the 
use  of  cups  and  leeches,  that  they  are  not  only 
useless,  but  often  hurtful,  if  applied  before  the  ac- 
tion of  the  pulse  is  reduced.  By  inducing  de- 
bility in  the  blood-vessels  of  the  brain,  they  invite 
morbid  excitement  to  it  from  the  blood-vessels  of 
the  trunk  and  extremities  of  the  body,  provided 
they  retain  a  predominance,  or  even  an  equality 
of  action  with  the  blood-vessels  of  the  brain. 

3.  SOLITUDE  is  indispensably  necessary  in  this 
state  of  madness.  The  passions  become  weak 
by  the  abstraction  of  company,  and  by  refrain- 
ing from  conversation.  For  this  reason,  visiters 
should  be  excluded  from  the  cells  and  apartments 
of  highly  deranged  people,  and  there  are  times  in 
which  the  visits  of  a  physician,  and  of  the  cell- 
keeper  or  nurse,  should  be  as  seldom  and  short 
as  are  consistent  with  the  proper  treatment  and 
care  of  the  patient. 


190  ON  THE  DISEASES 

4.  DARKNESS  should  accompany  solitude  in  the 
first  stage  of  this  disease.     It  invites  to  silence, 
and  it  induces  a  reduction  of  the  pulse,  by  the 
abstraction  of  the  stimulus  of  light,  and  by  the 
influence  of  fear,  which  is  naturally  connected 
with  darkness.    There  are  four  cells  in  the  Penn- 
sylvania Hospital,  so  formed  that  it  is  possible  to 
render  them  dark  with  but  little  trouble.     I  have 
seen  the  happiest  effects  from   confining  noisy 
patients  in  them. 

5.  An  ERECT  position  of  the  body.     There  is  a 
method  of  taming  refractory  horses  in  England, 
by  first  impounding  them,  as  it  is  called,  and  then 
keeping  them  from  lying  'down  or  sleeping,  by 
thrusting  sharp  pointed  nails  into  their  bodies  for 
two  or  three  days  and  nights.     The  same  advan- 
tages, I  have  no  doubt,  might  be  derived  from 
keeping   madmen   in    a    standing    posture,  and 
awake,  for  four  and  twenty  hours,  but  by  different 
and   more   lenient   means.      Besides    producing 
several  of  the  effects  of  the  tranquillizing  chair,  it 
would  tend  to  reduce  excitement  by  the  expendi- 
ture of  excitability,  from  the  constant  exertion  of 
the  muscles  which   support  the  body.     The  de- 
bility thus  induced  in  these  muscles  would  attract 
morbid  excitement  from  the  brain  and  thereby 
relieve  the  disease.     That  benefit  would  arise 


OP  THE  MIND.  191 

from  preventing  sleep,  I  infer  from  its  salutary 
effects  in  preventing  delirium,  and  from  delirium 
being  always  increased  by  it  in  fevers  of  great 
morbid  excitement. 

6.  Low  DIET,  consisting  wholly  of  vegetables, 
and  those  of  the  least  nutritious  nature.  What 
would  be  the  effect  of  fasting  for  two  or  three 
days  in  this  state  of  madness  ?  I  am  disposed  to 
think  favourably  of  it,  from  a  fact  communicated 
to  me  by  a  gentleman  who  resided  twenty  years 
in  the  interior  parts  of  India.  He  informed  me 
that  the  wild  elephants,  when  taken,  are  always 
tamed  by  depriving  them  of  food,  until  they  dis- 
cover signs  of  great  emaciation.  They  are  then 
fed  with  mild  aliment,  and  soon  acquired  their 
usual  flesh,  but  without  the  least  return  of  their 
ferocity.  Fasting  is  calculated  to  act  in  two 
ways,  in  the  cure  of  tonic  madness:  1,  by  lessen- 
ing the  quantity  of  blood  by  the  abstraction  of 
aliment;  and  2,  by  exciting  the  disease  of  hunger 
in  the  stomach  to  such  a  degree,  as  to  enable  it 
to  predominate  over  the  disease  of  the  brain,  and 
by  that  means  attract  it  to  a  less  vital  part  of 
the  body.  The  effects  of  this  severe  remedy  in 
curing  inflammatory  dropsy,  render  it  still  more 
probable  that  it  might  be  employed,  with  advan- 
tage, in  this  disease  of  the  brain.  Against  its 


192  ON  THE  DISEASES 

use  it  may  be  said  that  the  ferocity  of  certain 
wild  animals  is  increased  by  hunger;  this  is  true, 
but  ferocity  is  not  derangement.  It  is  possible 
it  might  exist  for  a  little  while,  and  be  attended 
with  symptoms  totally  different  from  those  which 
take  place  in  madness,  and  of  a  nature  that  would 
yield  more  easily  to  the  power  of  medicine. 

The  drinks  of  a  patient  in  this  state  of  mad- 
ness, should  be  of  the  most  simple  kinds. 

7.  PURGING.  Cremor  tartar,  salts,  senna,  ca- 
lomel and  jalap,  have  all  been  employed  for  this 
purpose.  Their  use  is  indicated  by  the  obstruc- 
tions in  the  viscera,  and  torpor  of  the  alimentary 
canal,  which  generally  accompany  this  form  of 
madness.  There  are  cases  in  which  the  purges 
should  be  given  daily,  so  as  to  excite  an  artificial 
diarrhoea.  Nature,  as  I  shall  say  presently,  some- 
times cures  madness  in  this  way.  It  is  much  in 
favour  of  this  chronic  mode  of  purging,  that  few 
persons  are  ever  delirious  in  their  last  moments, 
who  die  of  discharges  from  their  bowels.  In  the 
mixture,  which  sometimes  takes  place,  of  mania, 
with  the  synochus  form  of  bilious  fever,  purging 
should  be  employed  more  freely  than  in  simple 
madness.  Calomel  and  jalap  should  be  preferred 
for  that  purpose. 


OF  THE  MIND.  193 

8.  EMETICS  are  spoken  of  very  differently  by 
authors.    Some  commend,  while  others  condemn, 
them.     When  they  have  done  harm,  it  must  have 
been  by  giving  them  before,  or  after,  the  system 
was  reduced  below  the  emetic  point.  When  given 
at  that  point,  they  have   done   good  in   many 
cases.     I  mentioned  formerly  their  manner  of  ope- 
rating, in  treating  of  their  efficacy  in  partial  de- 
rangement. 

9.  NITRE  has  done  the  same  service  in  this 
disease,  that  it  has  done  in  other  diseases,  which 
affect  the  blood-vessels.     Its  efficacy  is  increased 
by  such  additions  of  tartarized  antimony  and  calo- 
mel to  it,  as  shall  increase  its  disposition  to  act 
upon  the  bowels  and  skin. 

10.  BLISTERS,  like   emetics,  have  been  con- 
sidered as  remedies  of  doubtful  efficacy;  but  it  is 
only  because  they  have  not  been  employed  in  the 
manner,  or  at  the  precise  time,  that  was  neces- 
sary to  obtain  benefit  from  them.     In  a  letter 
which  I  received  in  the  year  1794,  from  Dr.  Wil- 
lis, senr.  he  informed  me  that  he  always  applied 
them  to  the  ankles  in  this  disease,  instead  of  the 
head  or  neck.     He  gave  no  reason  for  this  prac- 

.tice,  but  it  immediately  suggested  a  principle  to 
me,  from  which  I  have  derived  great  advantages, 

25 


194  ON  THE  DISEASES 

not  only  in  the  treatment  of  madness,  but  of 
several  other  diseases.  In  the  first  stage  of  tonic, 
or  violent,  madness,  the  disease  is  intrenched,  as 
it  were,  in  the  brain. — It  must  be  loosened,  or 
weakened,  by  depleting  remedies,  before  it  can 
be  dislodged,  or  translated  to  another  part  of  the 
body.  When  this  has  been  effected,  blisters  easily 
attract  it  to  the  lower  limbs,  and  thus  often  con- 
vey it  at  once  out  of  the  body.  The  same  reason- 
ing applies,  with  equal  force  and  the  same  prac- 
tice with  equal  success,  to  all  the  violent  diseases 
of  the  breast  and  bowels.  The  blisters  do  the 
same  service  when  applied  to  the  wrists,  and  still 
more  when  applied  at  the  same  time,  or  alter- 
nately, to  both  extremities.  After  the  complete 
reduction  of  the  pulse,  they  may  be  applied  with 
advantage  to  the  neck  and  head. 

11.  COLD,  in  the  form  of  air,  water,  and  ice. 
The  cold  air  should  be  applied  both  partially  and 
generally.  To  favour  its  partial  action,  the  hair 
should  be  cut  off,  and  shaved  from  every  part  of 
the  head.  Dr.  Moreau,  a  French  physician,  has 
related  a  cure  of  madness  performed  by  this  sim- 
ple remedy  alone.  How  far  the  hair,  by  its  sym- 
pathy with  the  brain,  which  it  discovers  by  pre- 
ternatural dryness  in  the  forming  state  of  many 
diseases,  and  by  the  alteration  in  its  figure,  colour, 


OP  THE  MIND.  1  95 

and  quantity,  from  the  influence  of  certain  emo- 
tions and  passions  of  the  mind,  may  increase  this 
disease,  we  know  not;  but  we  are  certain,  by  cut- 
ting off,  we  not  only  expose  the  head  to  a  greater 
degree  of  cold,  but  we  favour  by  it,  at  the  same 
time,  depletion  from  the  brain,  by  means  of  insen- 
sible perspiration;  for,  however  strange  it  may 
appear,  there  is  a  grade  of  action  in  the  perspir- 
ing vessels,  in  which  their  discharges  are  in- 
creased by  the  sedative  operation  of  cold. 

Cold  air,  by  its  action  upon  the  whole  body, 
has  likewise  done  service  in  this  state  of  madness. 
I  have  heard  of  two  instances,  in  which  it  was 
cured  by  the  patients  escaping  from  their  keepers 
in  the  evening,  and  passing  a  night  in  the  open 
air  in  the  middle  of  winter.  One  of  them  re- 
lapsed ;  in  the  other  the  cure  was  permanent. 

Cold  water  should  be  applied  in  like  manner  to 
the  head,  and  the  whole  body.  To  the  former  it 
should  be  applied  by  means  of  cloths,  or  a  blad- 
der, to  which  ice,  when  it  can  be  obtained,  should 
be  added ;  for  the  head,  from  its  greater  insensi- 
bility to  cold  than  any  other  part  of  the  body, 
feels,  in  but  a  feeble  degree,  the  coldness  of  sim- 
ple water.  I  have  found  this  to  be  a  more  effec- 
tual, as  well  as  a  more  delicate,  mode  of  applying 


196  ON  THE  DISEASES 

cold  to  the  head,  than  by  means  of  the  clay  cap, 
as  advised  by  Dr.  Cullin.  The  water,  or  ice, 
should  be  frequently  renewed,  and  they  should  be 
continued  for  several  days  and  nights.  The  sig- 
nal for  removing  them  should  be,  when  they  pro- 
duce chilliness,  and  sobbing  or  weeping  in  the 
patient.  The  advantages  of  these  cold  applica- 
tions to  the  head  will  be  much  increased,  by 
placing  the  feet  at  the  same  time  in  warm  water. 
The  circulation  is  thereby  more  promptly  equal- 
ized. The  reader  will  find  a  striking  instance  of 
the  efficacy  of  using  cold  and  warm  water  in  this 
manner  to  the  two  extremities,  by  my  advice,  in 
a  case  of  mania  published  by  Dr.  Spence,  of  Dum- 
fries, in  Virginia,  in  Dr.  Cox's  Medical  Museum. 

In  order  to  derive  benefit  from  the  application 
of  cold  water  to  the  whole  body,  it  should  be  im- 
mersed in  it  for  several  hours,  by  which  means 
we  prevent  the  re-action  of  the  system,  and  thus 
render  the  sedative  effects  of  the  water  perma- 
nent. Pumping  for  an  hour  or  two  upon  a  pa- 
tient, acts  in  the  same  way;  but  as  it  has  some- 
times been  employed  in  curing  a  fit  of  drunken- 
ness, and  may  be  considered  as  a  punishment, 
rather  than  a  remedy,  immersion  of  the  body 
should  be  preferred  to  it.  The  patience  and  in- 
sensibility of  the  system  to  cold  in  this  state  of 


OP  THE  MIND.  197 

the  system,  is  illustrated  by  a  striking  fact,  men- 
tioned by  Dr.  Currie  in  his  Medical  Reports.  He 
tells  us,  a  deranged  young  woman  slept  upon  a 
cold  floor  during  a  whole  night,  so  cold  as  to 
freeze  water  and  milk  upon  her  table,  without 
suffering  the  least  inconvenience  from  it. 

11.  A  SALIVATION.  I  mentioned  the  manner  in 
which  this  remedy  operated  upon  the  brain,  the 
bowels  and  the  mind,  in  treating  of  the  cure  of 
hypochondriac  derangement.  Too  much  cannot 
be  said  in  its  favour  in  general  madness.  I  once 
advised  it  in  a  case  of  this  disease  from  parturi- 
tion, in  which  the  patient  conceived  an  aversion 
from  the  infant  that  had  been  the  cause  of  her 
suffering.  On  the  day  that  she  felt  the  mercury 
in  her  mouth,  she  asked  for  her  infant,  and  pressed 
it  to  her  bosom.  From  that  time  she  rapidly  re- 
covered. 

It  is  sometimes  difficult  to  prevail  upon  patients 
in  this  state  of  madness,  or  even  to  compel  them, 
to  take  mercury  in  any  of  the  ways  in  which  it  is 
usually  administered.  In  these  cases  I  have  suc- 
ceeded, by  sprinkling  a  few  grains  of  calomel  daily 
upon  a  piece  of  bread,  and  afterwards  spreading 
over  it,  a  thin  covering  of  butter. 


198  ON  THE  DISEASES 

12.  The  PERUVIAN  BARK.     In  all  those  cases  in 
which  mania  is  complicated  with  the  intermitting 
fever,'  or  with  those  prostrate  states  of  fever,  in 
which  bark  is  usually  administered,  this  medicine 
may  be  given  with  advantage. 

I  have  thus  enumerated  the  principal  remedies, 
which  have  been  employed  in  reducing  the  pre- 
ternatural excitement  of  the  system  which  takes 
place  in  tonic  madness.  There  are  some  others 
which  have  been  employed  for  the  same  purpose, 
upon  which  I  shall  make  a  few  remarks. 

13.  OPIUM.     From  an  erroneous  belief  in  the 
supposed  sedative  power  of  this  medicine,  it  has 
been  prescribed  in  this  state  of  derangement,  but 
I  believe  always  with  bad  effects.     When  given 
in  small  doses,  so  as  to  prevent  sleep,  and  by  that 
means  gradually  to  waste  the  excitability,  or  what 
Dr.  Darwin  calls  the  sensorial  power  of  the  sys- 
tem, it  may  be  useful. 

14.  DIGITALIS.     I   have  occasionally  adminis- 
tered this  medicine  in  tonic  madness,  but  never 
with  any  radical  or  permanent  success. 

15.  CAMPHOR  has  been  supposed  to  possess  spe- 
cific virtues  in  this  state  of  madness.  I  have  often 


OF  THE  MIND.  199 

prescribed  it  when  a  young  practitioner,  but  with- 
out any  obvious  advantage.  I  should  feel  some  he- 
sitation in  bearing  a  testimony  against  this,  and 
the  preceding  medicine,  had  I  not  lately  discover- 
ed that  my  experience  of  their  inefficacy  in  this 
disease,  accords  with  that  of  the  ingenious  Dr. 
Ferriar.  They  have  both  derived  their  credit  in 
madness  from  their  lessening  the  frequency  of  the 
pulse,  in  which  disease  has  very  improperly  been 
supposed  to  consist.  But  the  frequency  of  a  pulse 
may  be  lessened,  without  a  reduction  of  its  force, 
and  even  both  may  be  effected  by  these  medicines 
upon  the  pulse  on  the  wrist,  and  yet  irregular 
action  in  the  blood-vessels  of  the  brain,  which 
constitutes  the  disease,  still  continue,  and  until 
this  be  removed,  they  are  calculated  to  do  harm, 
by  inducing  obstruction  in  the  brain,  and  thereby 
perpetuating  the  disease. 

When  madness  arises  from  drunkenness,  those 
medicines  are  safer  and  more  useful,  than  when  it 
arises  from  those  causes  which  require  copious 
blood-letting.  In  addition  to  them,  volatile  salts, 
bitters,  and  small  quantities  of  ardent  spirits,  may 
be  given  with  advantage,  provided  the  system  be 
first  moderately  reduced  by  the  use  of  depleting 
remedies. 


200  ON  THE  DISEASES 

I  suspect  many,  and  perhaps  all,  the  cures  that 
have  been  performed  by  opium,  digitalis,  and  cam- 
phor, have  been  of  madness  from  the  intemperate 
use  of  strong  drink.  The  disease  in  most  of  these 
cases  partakes  of  the  nature  of  a  soap  bubble. 
With  all  its  apparent  force,  it  is  both  feeble,  and 
transient,  and  not  only  bears  stimulants  with 
safety,  but  sometimes  requires  them  immediately 
after  gentle  evacuations  of  any  kind. 

16.  HELLEBORE  has  been  famed  for  many  cen- 
turies, as  a  specific  for  madness.     It  is  generally 
admitted  that.it  is  useful,  only,  when  it  acts  as  a 
purge. 

17.  Dr.  Gregory,  senr.  used  to  relate,  in  his 
lectures,  a  method  of  curing  tonic  madness,  which 
was  practised  by  a  farmer  in  the  neighbourhood 
of  Aberdeen,  in  Scotland.    It  consisted  in  yoking 
a  number  of  madmen  in  a  plough,  and  compelling 
them,  by  fear  or  force,  to  plough  the  fields.     This 
remedy  acted,  by  reducing  and  expending  the 
morbid  excitement  of  the  system.   Refractory  do- 
mestic animals   are   sometimes  subdued  in  the 
same  way;  but  experience  has  taught  us  that  they 
may  be  tamed  by  more  gentle  means.     Experi- 
ence has  proved,  in  like  manner,  that  the  system 
in  tonic  madness  may  be  reduced  by  remedies 


OP  THE  MIND.  201 

that  offer  less  violence  to  humanity,  and  that 
do  not  add  to  the  affliction  of  the  disease,  by  de- 
grading the  patient  to  a  level  with  our  domestic 
animals. 

18.  As  soon  as  the  disease  shows  signs  of 
abatement,  the  patient  should  be  relieved  from 
his  confinement,  in  order  to  partake  of  the  benefits 
of  fresh  air  and  exercise.    Swinging,  riding  in  a 
carriage,  and  moderate  walking,  will  be  highly 
proper  in  this  state  of  his  disease.  To  these  should 
be  added. 

19.  The  SHOWER  BATH.   This  excellent  remedy 
acts  upon  the  head,  by  the  stimulus  arising  from 
the  weight  and  momentum  of  the  water,  and  by 
the  reaction  of  the  blood-vessels,  after  the  seda- 
tive effects  of  the  water  are  over.     I  have  seen 
very  happy  results  from  it.     To  do  much  service, 
it  should  be  used  two  or  three  times  a  day. 

20.  The  diet  and  drinks  of  the  patient  should 
now  be  of  a  cordial  nature;  and  where  obstinate 
wakefulness  or  restlessness  attends,  opium  may  be 
given  at  bed-time  with  safety  and  advantage. 

21.  When  the  disease  affects  the  nervous  and 
muscular  systems,  in  common  with  the  blood-ves- 

26 


202  ON  THE  DISEASES 

sels,  with  hysterical  or  convulsive  symptoms ;  as- 
safcetida,  castor,  and  the  oil  of  amber,  should  be 
given  with  all  remedies  that  have  been  men- 
tioned. 

II.  We  come  next  to  mention  the  remedies  that 
are  proper  to  act  upon  the  body  through  the  me- 
dium of  the  mind. 

1.  The  first  remedy  under  this  head,  is  to  di- 
vert the  ruling  passion  or  subject  which  occu- 
pies the  mind,  if  it  be  one,  and  fix  it  upon  some 
other.  Nothing  effectual  can  be  done  without 
great  attention  to  this  direction.  The  author 
has  endeavoured  to  show,  in  an  inquiry  into  the 
influence  of  physical  causes  upon  morals,  how 
much  the  passions  may  be  made  to  neutralize 
and  decompose  each  other,  and  thus  to  lessen 
their  influence  upon  the  body.  History  furnishes 
several  examples  of  the  truth  of  this  remark.  I 
mentioned  formerly  the  effects  of  opposing  the 
fear  of  shame  to  a  false  opinion  in  religion,  in  pre- 
venting suicide  in  the  virgins  of  Miletus.  Achil- 
les was  diverted  by  his  mother  Thetys  from  grati- 
fying his  revenge  upon  the  body  of  Hector,  by 
supplanting  that  baneful  passion  by  the  passion  of 
love.  Anger,  and  even  rage,  have  often  been  op- 
posed with  success  by  terror  and  fear,  and  delibe- 


OF  THE  MWD.  203 

rate  malice  by  a  delicate  stroke  of  wit.  Where 
the  mind  is  deranged  upon  all  subjects,  we  should 
endeavour  to  fix  it  upon  but  one.  In  order  to  do 
this,  it  will  be  necessary  to  find  out  the  favourite 
studies  and  amusements  of  our  patients.  The  late 
Dr.  Ash,  Dr.  Priestly  informed  me,  was  cured  of 
derangement  upon  a  variety  of  subjects  by  seducing 
him  to  the  study  of  mathematics,  of  which  he  had 
been  fond  in  early  life.  The  distracted  mind  of 
the  poet  Cowper  was  composed,  while  he  was  em- 
ployed in  the  single  business  of  translating  Homer; 
and  I  have  heard  of  a  woman  who  was  cured  of 
madness,  by  keeping  her  constantly  employed  for 
several  days  in  playing  cards,  to  which  it  was 
known  she  had  always  had  a  strong  attachment. 
There  are  few  persons  so  much  deranged,  as  not 
to  exhibit,  for  a  half  an  hour  or  more,  marks  of 
correctness  of  mind,  when  drawn  into  conversation 
upon  some  subject  not  connected  with  their  de- 
rangement. I  admit  that  this  diversion  of  the  pas- 
sions and  understanding  can  not  be  effected,  where 
the  whole  mind,  and  all  the  passions,  are  under 
the  influence  of  madness.  Thus  the  virgins  of 
Miletus  could  not  have  been  cured  by  an  appeal  to 
the  female  sense  of  shame,  had  their  moral  faculties 
partaken  of  the  disease  of  their  other  passions ;  nor 
could  Dr.  Ash  have  been  cured  of  his  intellectual 


204  ON  THE  DISEASES 

derangement  by  the  study  of  mathematics,  had  he 
lost  all  his  recollection  of  quantity  and  numbers. 

2.  A  sudden  sense  of  the  ABSURDITY,  FOLLY, 
or  CRUELTY  of  certain  actions,  produced  by  con- 
versation, has  sometimes  cured  madness.     The 
cure  in  this  case  bears  a  resemblance  to  the  sud- 
den reduction  of  a  dislocated  bone.     Some  years 
ago  a  maniac  made  several  attempts  to  set  fire  to 
our  hospital.     Upon  being  remonstrated  with,  by 
Mr.  Coates,  one  of  its  managers,  he  said,  "  I  am 
a  salamander ;"  "  but  recollect  (said  Mr.  Coates) 
all  the  patients  in  the  hospital  are  not  salaman- 
ders ;"  that  is  true,  said  the  maniac,  and  never  af- 
terwards attempted  to  burn  the  hospital.     Many 
similar  instances  of  a  transient  return  of  reason, 
and  some  of  cures,  by  pertinent  and  well  directed 
conversations,  are  to  be  met  with  in  the  records 
of  medicine. 

3.  Madness  has  sometimes  been  cured  by  the 
influence    of  PLACE,   TIME,    and    COMPANY,    upon 
the  human  mind.     In  favour  of  the  benefits  of  as- 
sociation from  place  1  shall  mention  the  following 
facts.     Van  Swieten  relates  a  story  of  a  cabinet- 
maker, who  always  recovered  his  reason  as  soon 
as  he  entered  his   work-shop.     A  certain  Mrs. 
D ,  of  this  city,  formerly  a  patient  of  mine,  on 


OF  THE  MIND.  205 

the  27th  of  March,  1792,  was  suddenly  seized 
with  derangement  on  her  way  from  market.  She 
rambled  for  two  hours  up  and  down  the  city,  and 
at  length  was  conducted  to  her  own  house.  The 
moment  she  looked  around  her,  she  recovered  her 
reason,  nor  did  she  relapse  afterwards.  I  have 
known  one  clergyman,  and  have  heard  of  another, 
who  were  deranged  at  all  times,  except  when  they 
ascended  the  pulpit,  in  which  place  they  discover- 
ed in  their  prayers  and  sermons,  all  the  usual 
marks  of  sound  and  correct  mind.  I  once  attend- 
ed a  judge  from  a  neighbouring  state,  who  was 
rational  and  sensible  upon  the  bench,  but  constant- 
ly insane  when  off  it.  Time,  by  its  influence  upon 
a  deranged  mind,  sometimes  produces  healthy 
and  regular  associations  of  ideas  and  conduct. — 
The  late  Rev.  Dr. ,  of  Baltimore,  was  ob- 
served to  be  less  deranged  on  Saturday,  than  on 
any  other  day  of  the  week,  probably  from  that  day 
being  formerly  devoted  exclusively  to  retirement 
and  study,  in  preparing  for  the  exercises  of  the 
ensuing  Sabbath.  Company  has  a  similar  effect 
in  restoring  healthy  and  regular  associations  in 
the  mind.  It  should  always  be  of  that  kind  which 
produced  respect  in  former  times.  It  will  readily 
occur  to  the  reader,  that  all  these  remedies,  de- 
rived from  association,  will  be  proper  only  in  the 
declining  and  moderate  state  of  the  disease. 


206  ON  THE  DISEASES 

4.  Great  care  should  be  taken  by  a  physician, 
to  suit  his  conversation  to  the  different  and  vary- 
ing states  of  the  minds  of  his  patients  in  this  dis- 
ease. In  its  furious  state,  they  should  never  be 
contradicted,  however  absurd  their  opinions  and 
assertions  may  be,  nor  should  we  deny  their  re- 
quests by  our  answers,  when  it  is  improper  to  grant 
them.  In  the  second  grade  of  this  disease,  we 
should  divert  them  from  the  subjects  upon  which 
they  are  deranged,  and  introduce,  as  if  it  were  ac- 
cidentally, subjects  of  another,  and  of  an  agreea- 
ble, nature.  When  they  are  upon  the  recovery, 
we  may  oppose  their  opinions  and  incoherent  tales 
by  reasoning,  contradiction,  and  even  ridicule.  I 
attended  a  lady  some  years  ago  in  our  hospital, 
in  whom  this  practice  succeeded  to  my  wishes. 
In  the  first  and  raving  state  of  her  disease,  she 
said  the  spirit  of  General  Washington  visited  and 
conversed  with  her  every  night.  I  took  no  notice 
of  this  assertion,  but  prescribed  only  for  the  ex- 
cited state  of  her  pulse.  After  this  was  reduced, 
I  entered  into  conversation  with  her,  and  instantly 
obtruded  a  subject  foreign  to  the  nightly  visits  of 
the  spirit  of  General  Washington,  whenever  she 
mentioned  it.  One  day,  when  she  appeared  ra- 
tional upon  all  the  subjects  upon  which  we  con- 
versed, she  lifted  up  the  skirt  of  her  silk  gown, 
and  said,  "  See  what  a  present  General  Washing- 


OF  THE  MIND.  207 

ton  made  me  last  night !"  O !  fie !  said  I,  madam, 
I  thought  you  had  more  understanding  than  to 
suppose  General  Washington  would  leave  his  pre- 
sent abode,  to  bring  a  silk  gown  to  any  lady  upon 
the  face  of  the  earth.  She  laughed  at  this  rebuke, 
and  never  mentioned  the  name  of  General  Wash- 
ington to  me  afterwards,  nor  discovered  any  other 
mark  of  the  remains  of  her  disease. 

From  the  history  of  this  case,  we  see  there  are 
the  same  acquiescing,  diverting,  and  opposing 
points  in  this  grade  of  madness  that  were  men- 
tioned in  treating  upon  the  cure  of  tristimania, 
and  amenomania,  all  of  which  should  be  carefully 
attended  to  in  conversing  with  persons  who  are 
affected  with  it. 

We  see  further  from  this  case,  that  the  cure  of 
mental  and  bodily  diseases  is  to  be  effected  by  the 
same  means.  We  first  reduce  the  system,  then 
create  revulsive  actions,  and  finally  remove  sub- 
sequent debility,  or  feeble  morbid  actions,  by 
stimulating  remedies.  From  the  nature  of  the 
last  of  these  remedies,  the  necessity  of  rescuing 
maniacal  patients  from  solitude  must  be  very  ob- 
vious, in  order  to  their  producing  a  salutary  effect. 
Indeed  they  should  never  be  confined  a  day  af- 


208  ON  THE  DISEASES 

ter  they  cease  to  be  disposed  to  injure  themselves 
or  others. 

5.  The  return  of  regularity  and  order  in  the 
operations  of  the  mind  will  be  much  aided,  by 
obliging  mad  people  to  read  with  an  audible  voice, 
to  copy  manuscripts,  and  to  commit  interesting 
passages  from  books  to  memory.  By  means  of 
the  first,  their  attention  will  be  more  intensely  fix- 
ed upon  one  subject  than  by  conversation.  In 
this  way  only,  they  read  when  alone,  and  in  this 
way  only,  they  comprehend  what  they  read.  They 
revert  in  this  respect  to  the  state  of  childhood. — 
By  copying  manuscripts,  the  attention  will  be 
still  more  fixed  to  one  subject,  and  abstracted 
from  all  others.  I  have  witnessed  the  most  salu- 
tary effects  from  it,  particularly  in  a  gentleman 
from  New  England,  whose  cure  was  completed 
by  transcribing  a  volume  of  lectures  for  a  student 
of  medicine.  Committing  select  passages  from 
books  to  memory  will  be  more  useful  than  either 
of  them,  inasmuch  as  it  requires  greater  efforts  of 
mind  to  accomplish  it.  To  facilitate  this  mode 
of  exciting  and  regulating  the  faculties  and  opera- 
tions of  the  mind,  a  few  entertaining  books  of  his- 
tory, travels,  and  prints,  should  compose  a  part 
of  the  shop  furniture  of  every  public  and  private 
mad-house. 


OF  THE  MIND.  209 

6.  Music  has  been  much  commended  in  this 
state  of  madness.     History  records  two  cures  of 
royal  patients  being  effected  by  it.    Dr.  Cox  men- 
tions a  striking  instance  of  its  power  over  the 
mind  of  a  madman.     It  should  be  accommodated 
to  the  state  of  the  disease.     In  that  grade  of  it 
which  is  now  under  consideration,  the  tunes  should 
be  of  a  plaintive,  that  is,  of  a  sedative  nature. 

7.  TERROR   acts  powerfully   upon  the  body, 
through  the  medium  of  the  mind,  and  should  be  em- 
ployed in  the  cure  of  madness.  I  once  advised  gentle 
exercise  upon  horseback,  in  the  case  of  a  lady  in 
Virginia  who  was  deranged.   In  one  of  her  excur- 
sions from  home,  her  horse  ran  away  with  her.  He 
was  stopped  after  a  while  by  a  gate.   The  lady  dis- 
mounted, and  when  her  attendants  came  up  to  her, 
they  found  her,  to  their  great  surprise,  and  joy,  per- 
fectly restored  to  her  reason,  nor  has  she  had  since 
the  least  sign  of  a  return  of  her  disease.  A  fall  down 
a  steep  ridge  cured  a  mania  of  twenty  years  continu- 
ance.  Dr.  Joseph  Cox  relates  three  cures  of  mad- 
ness by  nearly  similar  means.     Dr.  M.  Smith,  of 
Georgia,  informed  me,  that  a  madman  had  been 
suddenly  cured  in  Virginia,  by  the  breaking  of  a 
rope,  by  which  he  had  been  let  down  into  a  well 
that  was  employed  as  a  substitute  for  a  bathing 
tub.  He  was  nearly  drowned  before  he  was  taken 

27 


210  ON  THE  DISEASES 

out.  The  cures  in  all  these  cases  were  effected, 
by  the  new  actions  induced  in  the  brain  by  the 
powerful  stimulant  that  has  been  mentioned.  In 
the  use  of  it  great  care  will  be  necessary  to  suit 
its  force  to  the  existing  state  of  the  system. 

8.  FEAR,  accompanied  with  PAIN,  and  a  sense  of 
SHAME,  has  sometimes  cured  this  disease.  Bartho- 
lin  speaks  in  high  terms  of  what  he  calls  "  flagel- 
lation," in  certain  diseases.     I  have  heard  of  se- 
veral instances  of  its  efficacy  in  tonic  madness. 
Two  soldiers  were  cured  by  it  in  the  American 
army  during  the  revolutionary  war.     A  madman, 
who  escaped  from  his  keepers  in  Maryland,  ran  to 
one  of  his  neighbours  with  an  intention  to  kill  him. 
His  neighbour  met  him  with  a  heavy  whip,  and 
beat  him  until  he  fell  upon  his  knees,  and  implored 
him  to  spare  his  life.  He  rose  from  his  knees  in  a 
sound  state  of  mind,  and  had  no  symptom  of  his  dis- 
ease afterwards.     In  mentioning  the  cures  per- 
formed by  the  whip,  let  it  not  be  supposed  that  I 
am  recommending  it  in  this  state  of  madness.  Fear, 
pain,  and  a  sense  of  shame,  may  be  excited  in  many 
other  ways,  that  shall  not  leave  upon  the  memory 
of  the  patient  the  distressing  recollection,  that  he 
owes  his  recovery  to  such  a  degrading  remedy. 

9.  How  far  artificial  GRIEF  might  be  employed 


OP  THE  MIND.  211 

with  advantage  in  this  disease,  I  shall  not  deter- 
mine, but  I  have  heard  of  its  having  been  suspend- 
ed for  several  days,  in  a  clergyman  now  in  the 
Pennsylvania  Hospital,  by  the  death  of  one  of  his 
children;  and  of  mania  of  five  years  standing,  de- 
scending to  manalgia,  in  a  lady  in  New  York,  by 
hearing  of  the  death  of  her  husband.  It  caused 
her  to  weep  for  several  weeks.  The  disease  in  this 
case,  which  had  been  diffused  through  all  her  pas- 
sions, was  suddenly  concentrated  in  but  one  of 
them,  and  in  her  understanding,  from  whence  it 
gradually  passed  out  of  her  system.  If  these  facts 
should  not  be  deemed  a  sufficient  warrant  to  cre- 
ate artificial  grief,  they  will  show  that  relief  may 
be  expected,  from  communicating  to  persons  af- 
fected with  this  grade  of  madness  the  intelligence 
of  the  death  of  their  relations  and  friends. 

10.  Convalescents  from  derangement  should  be 
defended  from  the  TERRIFYING  or  DISTRESSING 
NOISES  of  patients  in  the  raving  state  of  this  dis- 
ease, by  removing  the  latter  to  small  lodges,  re- 
mote from  the  hospital,  or  private  mad-houses,  or 
by  confining  them  in  cells  that  are  made  with  dou- 
ble walls,  doors,  and  windows,  so  as  to  obstruct 
the  passage  of  sound.  A  relapse  has  often  been 
induced  by  the  neglect  of  this  caution. 


212  ON  THE  DISEASES 


CHAPTER  VII. 

II.  Of  Manicula. 

THIS  second  grade  of  general  madness,  which 
I  have  called  manicula,  differs  from  mania,  as 
chronic  rheumatism  differs  from  that  which  is 
acute,  that  is,  in  being  accompanied  with  a  more 
moderate  degree  of  the  same  symptoms.  The 
pulse  is  usually  synocula,  typhoid  or  typhus. 
It  is  in  this  case  of  madness  that  we  discover  that 
peculiar  sensibility  to  cold,  which  is  generally 
absent  in  its  highest  and  lowest  grades.  Shaks- 
peare,  who  saw  this  disease  in  common  life,  and 
out  of  the  restraints  and  conveniences  of  a  hospi- 
tal, has  very  happily  illustrated  this  symptom  in 
the  character  of  Edgar,  whom  he  often  makes  to 
exclaim,  in  counterfeiting  madness,  "  poor  Tom's 
a  cold."  From  the  operations  of  fresh  exciting 
causes,  manicula  now  and  then  rises  into  mania, 
in  which  state  it  is  sometimes  cured,  but  it  oft- 
ener  descends  in  a  few  days  or  weeks  to  its  chro- 
nic, or  habitual  form.  It  is  now  and  then  com- 


OF  THE  MIND.  213 

bined  with  typhus  fever,  in  which  state  it  has  been 
called  by  Dr.  Cullen,  typhomania.  We  see  it 
occasionally  in  the  last  stage  of  the  puerperal, 
the  jail,  and  autumnal  fever. 

The  REMEDIES  for  this  grade  of  madness  should 
be  the  same  in  its  inflammatory  state  as  for  mania, 
but  of  less  force.  In  its  typhoid  and  typhus  states, 
they  should  be  the  same  as  in  the  declining  state 
of  mania,  with  the  addition  of  garlic  in  substance 
or  infusion,  and  the  different  preparations  of  iron. 
In  the  typhomania,  the  remedies  should  be  com- 
bined with  those  usually  employed  in  the  treat- 
ment of  typhus  fever,  particularly  bark  and  opium. 
The  latter  is  an  invaluable  medicine  in  such  cases. 
The  dose  of  it  should  be  much  larger  than  in 
common  diseases  of  the  same  grade  of  action. 


214  ON  THE  DISEASES 


CHAPTER  VIII. 
III.  Of  Manalgia. 

THE  symptoms  of  this  third  and  last  form  of  ge- 
neral madness  are,  taciturnity,  downcast  looks,  a 
total  neglect  of  dress  and  person,  long  nails  and 
beard,  dishevelled  or  matted  hair,  indifference  to 
all  surrounding  objects,  insensibility  to  heat  and 
cold.  A  remarkable  instance  of  insensibility  to  the 
latter  occurred  in  a  certain  Thomas  Perrin,  who 
was  admitted  into  the  Pennsylvania  Hospital,  with 
manalgia,  in  March  1765,  and  who  died  there  in 
September  1774,  during  all  which  time  he  ate  and 
slept  in  the  cupola  of  the  hospital,  and  never,  in 
the  coldest  weather  of  nine  winters,  came  near  to 
a  fire.  A  fixed  position  of  the  body  sometimes  at- 
tends this  form  of  madness.  Of  this  there  have 
been  two  remarkable  instances  in  our  hospital. 
In  one  of  them,  the  patient  sat  with  his  body  bent 
forwards  for  three  years  without  moving,  except 
when  compelled  by  force,  or  the  calls  of  nature.  In 


OP  THE  MIND.  215 

the  other,  the  patient  occupied  a  spot  in  a  ward,  an 
entry,  or  in  the  hospital  yard,  where  he  appeared 
more  like  a  statue  than  a  man.  Such  was  the  tor- 
por of  his  nervous  system,  that  a  degree  of  cold, 
so  intense  as  to  produce  inflammation  and  gan- 
grene upon  his  face  and  limbs,  did  not  move  him 
from  the  stand  he  had  taken  in  the  open  air.  The 
cause  of  this  young  man's  insanity  was  as  singular 
as  its  nature.    In  was  induced  by  his  father's  sell- 
ing a  pleasant  farm,  upon  the  Delaware,  in  the 
neighbourhood  of  Philadelphia,  on  which  he  was 
born,  and  had  passed  his  youth,  and  which  he  ex- 
pected to  inherit  after  the  death  of  his  father.  The 
skin  in  manalgia  is  dry,  cold,  pale,  yellow,  brown, 
livid,  and  dark  coloured,  and  now  then  covered 
here  and  there  with  black  spots.    The  eyes,  when 
originally  dark,  acquire  a  light  colour  in  this  dis- 
ease.    I  took  notice  formerly  of  the  prevalence  of 
this  colour  in  the  deranged  patients  in  the  Penn- 
sylvania Hospital.  It  probably  arises  from  the  ten- 
dency of  the  system  to  dissolution,  for  we  frequently 
see  it  in  the  last  stage  of  pulmonary  consumption, 
and  it  rarely  fails  to  take  place  in  old  age.     The 
appetite  in  manalgia  is  inordinate  or  weak,  the 
bowels  are  costive,  the  urine  is  scanty  in  quantity, 
and  there  is  sometimes  a  discharge  or  slabbering 
of  saliva.     This  symptom,  with  one  other,  was  se- 


216  ON  THE  DISEASES 

lected  by  David,  when  he  counterfeited  madness 
in  order  to  prevent  the  discovery  of  his  person 
by  the  king  of  Gath,  after  his  escape  from  the 
hands  of  Saul.     "  And  he  changed  his  behaviour 
before  them  (says  the  sacred  historian)  and  feign- 
ed himself  mad,  and  scrabbled  upon  the  doors  of 
the  gate,  and  let  his  spittle  fall  down  upon  his 
beard."     The  discharge  of  saliva  in  this  case  ap- 
peared to  be  involuntary,  and  in  this  we  perceive 
a  distinguishing  mark  between  manalgia  and  tonic 
madness,  in  the  latter  of  which  I  said  formerly 
the  saliva  is  discharged  with  difficulty  by  spit- 
ting.    The  respiration  is  slow,  the  breath  and 
perspiration  have  a  peculiar  and  offensive  smell, 
and  the  puke  is  languid  and  frequent,  but  some- 
times natural.     Nebuchadnezzar  seems  to  have 
been  affected  with  this  low  grade  of  madness. 
He  was  said  to  resemble  a  beast,  probably  from 
the  uncommon  growth  of  his  hair,  beard,  and 
nails. 

A  strong  attachment  to  tobacco  is  common  in 
the  patients  who  have  been  previously  in  the  habit 
of  using  it.  They  frequently  ask  strangers  for  it, 
or  a  few  cents  to  buy  it. 

These  are  the  usual  symptoms  of  manalgia  in 
hospitals,  but  when  persons  who  are  affected  with 


OF  THE  MIND.  217 

it  passes  their  liberty,  they  rather  seek  for,  than 
shun  human  society.  They  are  often  admitted  by 
private  families  to  pass  nights  in  their  kitchens, 
garrets,  or  barns.  Sometimes  they  wander  through 
neighbourhoods  in  the  capacity  of  beggars.  Shak- 
speare  has  described  this  state  of  derangement, 
-very  accurately,  in  the  character  of  Edgar,  in 
King  Lear,  when  he  makes  him  adopt  the  resolu- 
tion of  counterfeiting  the  character  of  a  madman. 

"  I  will,  (says  Edgar)  take  the  basest  and  poorest  shape, 

That  ever  penury,  in  contempt  of  man, 

Brought  near  to  beast.     My  face  I'll  grime  with  filth, 

Blanket  my  loins,  tie  all  my  hair  with  knots, 

And,  with  presented  nakedness,  outface 

The  winds  and  persecutions  of  the  sky : 

And  with  this  horrible  object,  from  low  farms, 

Poor  pelting  villagers,  sheep  cotes,  and  mills, 

Sometimes  with  lunatic  bans,  sometimes  with  prayers, 

Enforce  their  charity." 

There  are  some  instances  in  which  the  moral 
faculties  are  impaired  in  manalgic  patients,  in 
which  case  they  are  mischievous  and  vicious,  but 
they  are  more  generally  inoffensive,  and  disposed 
to  be  kind,  and  even  useful  in  hospitals  and  fami- 
lies. In  some  of  them  the  sense  of  Deity  is  not 
only  unimpaired,  but  in  an  elevated  state.  The 
mad  poet,  Christopher  Smart,  often  kneeled  do\vn 

28 


218  ON  THE  DISEASES 

and  prayed  in  the  streets  of  London,  when  he  was 
permitted  to  leave  his  house,  and  he  never  suffer- 
ed any  of  his  visiters  to  leave  him  without  re- 
questing them  to  pray  with  him. 

A  late  poet  has  described  this  pious  form  of  ma- 
nalgia,  in  a  young  woman,  very  happily  in  the  fol- 
lowing lines : 

"  But  her  praise  was  still,  to  be 

Where  holy  congregations  bow. 

Wrapt  in  wild  transports,  while  they  sang, 

And  when  they  pray'd,  would  bow  her  low." 

Madness  in  this  form  sometimes  continues  for 
ten,  fifteen,  twenty,  and  even  fifty  years,  when 
not  accompanied  with  paroxysms,  but  it  more 
generally  terminates  in  death  in  a  shorter  time, 
and  frequently  by  diseases  to  be  mentioned  here- 
after. 

The  equanimity  of  temper,  together  with  the 
want  of  exercise,  and  the  inordinate  appetite, 
which  generally  accompany  this  disease,  some- 
times produce  obesity.  They  had  that  effect,  Dr. 
Johnson  tells  us,  upon  Mr.  Smart.  I  have  seen 
two  instances  of  it  in  Philadelphia. 


'    • 


OP  THE  MIND. 


219 


The  REMEDIES  for  MANALGIA  should  consist,  like 
those  under  a  former  head,  of  such  as  act, 

I.  Upon  the  mind,  through  the  medium  of  the 
body;  and, 

II.  Upon  the  body,  through  the  medium  of  the 
mind. 

I.  To  the  first  head  belong, 

1.  Cordial  food  and  drinks.  The  former  should 
be  made  savoury  and  grateful  to  the  taste,  and 
the  stimulus  from  the  pleasure  imparted  by  it 
should  be  increased  by  its  variety.  The  latter 
should  consist  of  wine,  cider,  and  malt  liquors. 
Ardent  spirits  should  be  given  with  great  caution, 
lest  a  destructive  fondness  should  be  acquired  for 
them.  There  is  least  danger  of  this  being  the 
case,  when  they  are  given  in  an  undiluted  state 
once  or  twice  a  week.  I  have  seen  the  most 
beneficial  effects  from  them,  when  administered 
in  this  manner.  To  patients,  in  whom  this  form 
of  madness  has  been  induced  by  intemperance  in 
drinking,  they  may  be  given  daily,  and  in  liberal 
quantities. 


220  ON  THE  DISEASES 

2.  The  WARM  BATH.  The  water  should  be 
heated  above  the  natural  temperature  of  the  body, 
in  which  state  it  acts  powerfully  upon  the  arterial 
system.  I  have  once  known  it  induce  150  strokes 
in  the  pulse  in  a  minute,  and  excite  the  brain  into 
delirium,  in  an  experiment  made  upon  himself  by 
a  student  of  medicine  in  the  University  of  Penn- 
sylvania. From  the  occasional  effects  of  fevers, 
which  act  in  a  similar  way  upon  the  blood-vessels, 
I  have  been  led  to  think  highly  of  the  remedy.  An 
epidemic  fever,  many  years  ago,  pervaded  the  cells 
of  our  hospital,  which  restored  the  greater  part  of 
the  maniacs  to  their  reason.  These  accidental 
cures  struck  the  late  Dr.  Bond  so  forcibly,  that  he 
attempted  to  exercise  a  fever  in  several  of  his  pa- 
tients in  manalgia  afterwards,  by  sending  them  to 
the  swamps  of  Gloucester  county,  near  to  the 
city,  in  the  state  of  New  Jersey.  With  what  suc- 
cess I  have  never  heard. 

3.  The  COLD  SHOWER  BATH.     The  impulse  im- 
parted to  the  head  by  the  descent  of  the  water 
upon  it,  adds  very  much  to  its  efficacy,  and  gives 
it  great  advantage  over  the  plunging  bath. 

4.  The  COLD  shower  bath  in  succession  to  the 
WARM  bath.     While  I  attended  the  Pennsylvania 
Hospital,  in  the  summer  of  1785, 1  often  employ- 


OF  THE  MIND.  221 

ed  these  two  remedies  in  the  manner  I  have  men- 
tioned. I  kept  my  torpid  patient  in  the  warm 
bath  for  an  hour  or  two,  and  then  led  him,  smok- 
ing with  vapour,  to  the  shower  bath,  which  gave  a 
most  powerful  shock  to  his  system.  It  extorted 
cries  and  groans  from  persons  that  had  been  dumb 
for  years.  In  one  case  it  relieved,  and  in  another, 
it  restored  reason  to  my  patient;  bat  from  his  be- 
ing confined  in  a  damp  cell,  he  died  some  time 
after  his  recovery  from  his  madness  of  a  pulmona- 
ry consumption. 

5.  Exciting  an  artificial  diarrhoea.    In  the  tonic 
state  of  madness,  purging,  I  said  formerly,  acted 
as  a  depleting  remedy.  In  manalgia  it  does  good, 
by  exciting  a  revulsive  action  or  disease,  in  a  less 
delicate  part  of  the  body  than  the  brain.    Nature, 
I  said  formerly,  sometimes  cures  manalgia  in  this 
way.     An  instance  of  a  cure  from  this  cause  oc- 
curred in  our  hospital  some  years  ago,  in  a  wo- 
man who  had  been  deranged  nine  years.  An  acute 
dysentery  cured  in  a  woman  in  Chester  county, 
after  it  had  continued  two  years.     It  may  be  ex- 
cited by  a  laxative  diet,  or  any  gently  opening 
medicine. 

6.  A  CAUSTIC  applied  to  the  back  of  the  neck, 
or  between  the  shoulders,  and  kept  open  for  months, 


222  ON  THE  DISEASES 

or  years.  This  remedy  acts  by  the  permanent 
discharge  it  induces  from  the  neighbourhood  of 
the  brain.  Four  patients  have  been  cured  of  ma- 
nalgia  in  our  hospital,  by  abcesses  in  different 
parts  of  the  body.  One  of  them  had  passed  a 
third  of  his  life  in  the  hospital.  Dr.  Johnson  tells 
us,  in  his  Lives  of  the  Poets,  that  Dean  Swift  had 
a  temporary  return  of  his  reason  during  the  con- 
tinuance of  an  abscess  in  his  eye. 

7.  A  SALIVATION.     I  know  it  is  difficult  to  ex- 
cite this  disease  in  the  throat  and  mouth  in  manal- 
gia,  but  the  mercury,  if  given  ineffectually  for  this 
purpose,  will  be  useful  as  a  general  stimulant  and 
tonic.     It  will  moreover  serve  to  remove  visceral 
obstructions,  which  so  generally  succeed  madness. 
Where  it  excites  a  salivation,  it  seems  to  resuscitate 
the  mind.  I  have  seen  two  instances  in  our  hospi- 
tal, in  which  a  taciturnity  of  a  year's  continuance 
was  removed  by  it.     Speech  was  excited,  in  one 
of  them,  on  the  very  day  on  which  the  mercury 
affected  the  mouth,  and  the  use  of  reason  follow- 
ed in  a  few  days  afterwards. 

8.  EXERCISE.      This  should  consist  of  swing- 
ing, seesaw,  and  an  exercise  discovered  by  Dr. 
Cox,  which  promises  more  than  either  of  them, 
and  that  is,  subjecting  the  patient  to  a  rotary  mo- 


OF  THE  MIND.  223 

tion,  so  as  to  give  a  centrifugal  direction  of  the 
blood  towards  the  brain.  He  tells  us  he  has  cured 
eight  persons  of  torpid  madness  by  this  mode  of 
exercise.  I  have  contrived  a  machine  for  this  pur- 
pose in  our  hospital,  which  produces  the  same  ef- 
fects upon  the  body  which  are  mentioned  by  Dr. 
Cox.  These  are  vertigo  and  nausea,  and  a  general 
perspiration.  I  have  called  it  Gyrater.  It  would 
be  more  perfect,  did  it  permit  the  head  to  be  placed 
at  a  greater  distance  from  its  centre  of  motion.  It 
produces  great  changes  in  the  pulse.  In  one  ex- 
periment made  with  it,  it  increased  the  pulse  from 
84  to  88  strokes  in  one  minute,  and  to  120  in  two 
minutes.  It  increased  its  fulness  at  the  same 
time.  In  a  second  experiment  made  upon  a  ma- 
nalgic  patient,  it  increased  the  frequency  of  the 
pulse  from  104  in  two  minutes  to  150.  In  a  third 
experiment  it  reduced  the  pulse  from  108  in  three 
minutes  to  100,  and  lessened  its  force.  In  this 
patient,  the  pulse  was  preternaturally  active  be- 
fore he  entered  the  gyrater. 

From  the  strong  impression  this  mode  of  ex- 
ercise makes  upon  the  brain,  there  is  reason  to 
believe  it  will  be  a  useful  remedy  in  manalgia. 
A  cheap  contrivance,  to  answer  all  its  purposes, 
might  easily  be  made,  by  placing  a  patient  upon  a 
board  moved  at  its  centre  upon  a  pivot,  with  his 


224  0\  THE  DISEASES 

head  towards  one  of  its  extremities,  and  then  giv- 
ing it  a  rotary  motion.  The  centrifugal  force  of 
the  blood  would  exceed,  in  this  way,  that  which 
it  receives  from  the  chair  employed  by  Dr.  Cox, 
or  from  the  gyrater  in  the  Pennsylvania  Hospital. 
In  addition  to  these  exercises,  pleasant  amuse- 
ments should  be  contrived  for  this  class  of  mad 
people.  If  they  are  unhappy,  these  amusements 
will  suspend  their  misery.  If  they  are  in  a  torpid 
state,  a  transient  sense  of  pleasure  will  be  excited 
by  them,  which  may  serve  to  remind  them  that 
the  chain  is  still  unbroken  which  united  them 
with  their  fellow  men. 

9.  LABOUR  has  several  advantages  over  exer- 
cise, in  being  not  only  more  stimulating,  but  more 
durable  in  its  effects,  whereby  it  is  more  calcu- 
lated to  arrest  wrong  habits  of  action,  and  to  re- 
store such  as  are  regular  and  natural.  It  has 
been  remarked  that  the  maniacs  of  the  male  sex 
in  all  hospitals,  who  assist  in  cutting  wood,  mak- 
ing fires,  and  digging  in  a  garden,  and  the  females 
who  are  employed  in  washing,  ironing,  and  scrub- 
bing floors,  often  recover,  while  persons,  whose 
rank  exempts  them  from  performing  such  ser- 
vices, languish  away  their  lives  within  the  walls 
of  the  hospital.  In  favour  of  the  benefits  of  la- 
bour, in  curing  this  disease,  I  shall  select  one  from 


OP  THE  MIND.  225 

among  many  facts  that  might  be  mentioned.    In 
the  year  1801, 1  attended  an  English  gentleman, 
soon  after  his  arrival  in  America,  who  was  afflict- 
ed with  this  grade  of  madness.     My  prescriptions 
relieved,  but  did  not  cure  him.     He  returned  to 
his  family  in  Maryland,  where,  in  the  time  of  hay 
harvest  he  was  allured  into  a  meadow,  and  pre- 
vailed upon  to  take  a  rake  into  his  hands,  and  to 
assist  in  making  hay.    He  worked  for  some  time, 
and  brought  on  thereby  a  profuse  sweat,  which 
soon  carried  off  his  disease.     This  account  of  his 
remedy  and  cure  I  received  from  himself,  in  a 
very  sensible  letter  written  a  few  weeks  after  his 
recovery.  I  have  often  wished,  and  lately  advised, 
that  the  mad  people  in  our  hospital  should  be 
provided  with  the  tools  of  a  number  of  mechani- 
cal arts.     Some  of  them  should  be  laborious,  and 
employ  the  body  chiefly;  others  ingenious,  and 
of  a  nature  to  exercise  and  divert  the  mind  more 
than  the  body.     None  of  them  should  be  carried 
on  by  instruments,  with  which  it  would  be  easy 
for  the  maniacs  to   hurt  themselves  or  others. 
For  certain  exploits  of  industry  or  skill,  they 
should  receive  such  rewards  in  food,  or  dress,  as 
accord  most  with  their  inclinations,  for  few  of 
them  are  capable  of  any  higher  or  other  gratifica- 
tion.    The  advantages  of  thus  producing  a  cur- 
rent of  new  actions,  both  corporeal  and  mental, 

29 


226  ON  THE  DISEASES 

which  should  continue  for  weeks  and  months,  and 
perhaps  years,  could  not  fail  of  being  accompa- 
nied with  great  advantages.  Some  emolument 
might  likewise  be  derived  from  their  labour  to 
their  friends,  or  to  the  institution  that  supported 
them.  What  a  different  view  would  a  number 
of  mad  people  exhibit,  all  thus  imitating  the 
habits  of  rational  industry,  compared  with  the 
antic  gestures,  the  rapid  or  sauntering  walks, 
the  listless  attitudes  and  the  vociferous  or  mut- 
tering conversations  they  hold  with  themselves, 
with  which  they  excite  pity  or  horror  in  all  who 
see  them. 

In  both  the  exercises  and  labours  of  mad  peo- 
ple, they  should  be  as  much  separated  from  each 
other  as  possible.  We  are  naturally  imitative 
animals  j  and  our  minds  are  formed  in  a  degree 
by  ambient  circumstances ;  for  which  reason  mad 
people  should  associate  and  work  only  with  per- 
sons of  sound  and  healthy  minds. 

10.  Music  should  not  be  omitted  as  a  remedy 
in  this  state  of  madness.  The  tunes  employed 
for  this  purpose  should  be  of  the  most  invigora- 
ting nature. 


OF  THE  MIND.  227 

11.  GREAT  PAIM.     Mr.  Stewart,  the  pedestrian 
traveller,  informed  me,  that  he  once  saw  a  tran- 
sient interval    of  reason   induced  upon  several 
idiots  in  Italy,  by  means  of  torture,  inflicted  from 
pious,  but  superstitious  motives  by  some  priests. — 
Dr.  Cox  mentions  an  instance  of  chronic  madness 
being  cured  by  trepanning,  and  of  the  same  good 
effects  being  produced  by  accidental  contusions  of 
the  head.    It  is  probable  that  both  acted  only  by 
inducing  pain.     The  return  of  reason  which  I 
shall  say  hereafter  sometimes  takes  place  in  the 
last  hours  of  life,  is  probably  occasioned,  in  part, 
by  the  bodily  pains  which  attended  the  passage 
out  of  life.     Should  this  remedy  be  resorted  to,  it 
should  be  induced  by  means  that  are  not  of  a  de- 
grading nature,  and  which  are  calculated  at  the 
same  time  to  excite  violent  passion  or  emotion  of 
the  mind. 

12.  ERRHINES.     These  are  suggested  by  the 
general  absence  of  secretion  in  the  nose  in  mad 
people,  and  by  the  relief  which  the  discharge  of  a 
few  drops  of  tears  affords  in  tristimania.     The 
insensibility  of  the  nose  to  the  stimulus  of  com- 
mon snuff,  from  its  habitual  use  by  that  class  of 
patients,  forbids  us  to  expect  any  benefit  from  it, 
for  which  reason  the  sulphate  of  mercury,  and  the 


228  ON  THE  DISEASES 

muriate  of  ammonia,  mixed  with  a  little  flour, 
should  be  preferred  for  that  purpose. 

13.  CERTAIN  ODOURS.    The  dyer,  formerly  men- 
tioned, informed  me,  that  he  had  often  observed 
the  men  that  were  employed  in  dyeing  scarlet  to 
be  uncommonly  cheerful,  and  sometimes  to  sing 
from  morning  till  night.     The  odour  which  pro- 
duces this  effect  is  derived  from  a  mixture  of  co- 
chineal with  a  solution  of  tin  in  the  nitric  acid. 
The  exhilaration  produced  by  the  fragrance  of  a 
flower  garden  in  the  spring  of  the  year,  and  of 
the  Spice  Islands  in  the  Indian  Ocean,  favours 
the  idea  still   more,  of  exciting  the    brain   by 
means  of  pleasant  odours  applied  to  the  organ  of 
smelling. 

14.  What  would  be  the  effect  of  loud  and  un- 
common SOUNDS,  acting  through  the  ears  upon  the 
brain  and  mind  in  this  disease  ?  Menalgic  patients, 
it  has  been  observed,  are  much  excited  by  the 
military  music  that  sometimes  passes  by  the  Penn- 
sylvania Hospital.  It  is  still  more  in  favour  of  loud 
sounds,  or  noises,  in  manalgia,  that  in  the  lowest 
stage  of  typhus  fever,  they  have  recalled  depart- 
ing life,  and  in  asphixa,  restored  it  from  its  appa- 
rent extinction  in  death. 


OP  THE  MIND.  229 

15.  Exciting  certain  stimulating  PASSIONS  and 
EMOTIONS,  also  the  domestic  AFFECTIONS.    I  men- 
tioned several  instances  of  the  good  effect  of 
terror,   in    tristimania  and  in  tonic  madness  in 
its   declining  state.     To  be  useful  in  manalgia, 
it  should  be  often  repeated.    Of  the  good  benefits 
of  anger,  I  shall  mention  a  striking  instance. — 
Mr.  Derborow,  whose  name  was  mentioned  for- 
merly, during  his  long  confinement  in  our  hospital, 
in  a  state  of  manalgia,  became  silent  for  several 
months.    Many  attempts  were  made  to  compel 
him  to  speak,  but  to  no  purpose.     The  late  Dr. 
Thomas  Bond  at  length  contrived  to  force  him 
to  break  his  long  and  obstinate  silence.     It  was 
the  practice  of  Mr.  Derborow  to  amuse  himself 
occasionally  during  this  time  in  drawing.     One 
day  the  Doctor  looked  over  his  shoulder,  and  saw 
the  picture  of  a  flower  under  his  pencil.   "  A  very 
pretty  cabbage,"  said  the  Doctor.     « You  are  a 
fool  and  a  liar,"  said  Mr.  Derborow,  "it  is  a 
flower."    From  that  time  he  continued  to  speak 
as  usual.     Reading  aloud  and  incorrect  to  pa- 
tients in  this  situation  has  sometimes  induced  a 
transient  feeling  of  uneasiness  or  irritation,  which 
has  unsealed  their  lips,  and  revived  their  former 
habits  of  conversation. 


230  ON  THE  DISEASES 

The  advantages  to  be  expected  from  exciting 
the  domectic  affections  will  appear  from  the  fol- 
lowing fact.  A  woman  in  our  hospital  was  de- 
livered many  years  ago,  of  a  fine  child  during 
her  derangement,  which  was  of  a  chronic  and  tor- 
pid nature.  The  affection  which  was  suddenly 
awakened  for  this  child,  removed  her  disease  for 
several  days.  The  child  was  taken  from  her  breast, 
lest  it  should  contract  the  seeds  of  madness  from 
her  milk.  Her  disease  immediately  returned,  and 
she  is  now,  and  probably  always  will  be,  an  incu- 
rable tenant  of  our  hospital. 

There  are  several  medicines  which  have  been 
given  in  this  disease,  upon  which  I  shall  make  a 
few  remarks.  These  are, 

16.  Opium,  iron,  the  datura  stammonium, 
strong  infusions  of  green  tea  and  green  coffee, 
garlic,  valerian,  the  nitrous  oxyd,  and  electricity. 

I  have  administered  all  these  medicines  in  this 
disease  in  the  Pennsylvania  Hospital,  and  some 
of  them  for  several  months,  but  never  in  a  single 
instance  with  success,  when  given  alone.  Garlic 
now  and  then  produced  a  temporary  frequency 
and  fulness  in  the  pulse,  and  electricity  has  pro- 
duced a  transient  excitement  in  the  temper,  but 


OF  THE  MIND.  231 

neither  of  them  made  a  permanent  impression 
upon  the  disease.  Where  a  recovery  has  suc- 
ceeded the  use  of  any  of  those  medicines,  I  have 
supposed  the  disease  was  cured  by  time,  instances 
of  which  will  be  mentioned  hereafter.  In  thus 
stating  the  inefficacy  of  the  above  medicines  in 
manalgia,  I  would  by  no  means  reject  them  alto- 
gether. They  may  be  given  as  auxiliaries  to  those 
more  powerful  and  rational  remedies  which  agi- 
tate the  whole  body  and  mind. 

In  the  use  of  all  our  remedies  for  manalgia,  an 
advantage  will  arise  from  prescribing  them  in 
succession  and  rotation,  and  in  choosing  certain 
seasons  of  the  year,  according  to  the  habits  of  the 
patient,  for  their  exhibition. 

To  encourage  us  to  persevere  for  years  in  the 
use  of  remedies  for  this  disease,  or  to  wait  for  a 
cure  from  the  hand  of  time,  founded  upon  those 
spontaneous  changes  that  are  always  going  for- 
ward in  the  human  body,  I  shall  select  two  cases 
of  recoveries  from  among  many  others,  the  one 
from  the  former,  the  other  from  the  latter  cause. 

1.  In  the  year  1795,  a  young  man  of  the  name 
of  Donaldson,  from  York  county,  in  Pennsylva- 
nia, was  admitted  into  our  hospital,  in  the  lowest 


232  ON  THE  DISEASES 

state  of  manalgia.  He  had  been  in  that  situation 
between  four  and  five  years.  He  appeared  to  have 
no  mind,  and  scarcely  any  locomotive  powers. 
When  placed  at  the  head  of  a  pair  of  stairs,  he 
rolled  to  the  bottom  of  it.  By  means  of  most  of 
the  remedies  I  have  recommended,  he  was  nearly 
cured.  He  acquired  the  use  of  his  speech,  knew 
his  attendants,  and  called  me  by  my  name  when  1 
visited  him.  Unhappily,  in  his  progress  to  a  per- 
fect cure  he  was  attacked  with  a  malignant  fever, 
and  died  in  the  hospital  on  the  fifth  day  of  his 
disease. 

2.  The  following  account  of  a  spontaneous  re- 
covery was  communicated  to  me,  many  years  ago, 
by  Dr.  A.  Hunter,  with  his  history  of  the  Lunatic 
Asylum,  in  York,  in  Great  Britain. 

"On  the  twenty-fifth  of  October,  1778,  a  sea- 
faring person,  about  forty  years  of  age,  was  re- 
commended to  the  Lunatic  Asylum  for  cure. — 
About  two  years  before  that  time  he  had  sustained 
considerable  loss  by  sea,  which  operated  so  vio- 
lently upon  his  mind,  as  to  deprive  him,  almost 
instantly,  of  all  his  reasoning  faculties.  In  that 
state  of  insensibility  he  was  received  into  the  Asy- 
lum. During  his  abode  there,  he  was  never  ob- 
served to  express  any  desire  for  nourishment;  and 


OP  THE  MIND.  233 

so  great  was  his  inattention  to  this  particular,  that 
for  the  first  six  weeks  it  was  necessary  to  feed  him 
in  the  manner  of  an  infant.     Food  and  medicines 
were  equally  indifferent  to  him.     A  servant  un- 
dressed him  at  night,   and  dressed  him  in  the 
morning;  after  which  he  was  conducted  to  his 
seat  in  the  common  parlour,  where  he  remained 
all  day  with  his  body  bent,  and  his  eyes  fixed  upon 
the  ground.     From  all  the  circumstances  of  his 
behaviour,  he  did  not  appear  to  be  capable  of  re- 
flection.    Every  thing  was  indifferent  to  him ;  and 
from  the  fairest  judgment  that  could  be  formed, 
he  was  considered  by  all  about  him  as  an  animal 
converted  nearly  into  a  vegetable.   In  this  state  of 
insensibility  he  remained  till  the  morning  of  Tues- 
day the  fourteenth  of  May,  1783,  when,  upon  en- 
tering the  parlour,  he  saluted  the  recovering  pa- 
tients with  a  "Good  morrow  to  you  all."    He 
then  thanked  the  servants  of  the  house,  in  the 
most  affectionate  manner,  for  their  tenderness  to 
him;  of  which,  he  said,  he  began  to  be  sensible 
some  weeks  before,  but  had  not  till  then  the  reso- 
lution to  express  his  gratitude.     A  few  days  after 
this  unexpected  return  to  reason,  he  was  permitted 
to  write  a  letter  to  his  wife,  in  which  he  expressed 
himself  with  decency  and  propriety.    At  this  time 
he  seemed  to  have  a  peculiar  pleasure  in  the  en- 
joyment of  the  open  air,  and  in  his  walks  con- 

30 


234  ON  THE  DISEASES 

versed  with  freedom  and  serenity.  Talking  with 
him  on  what  he  felt  during  the  suspension  of  rea- 
son, he  said  that  his  mind  was  totally  lost;  but 
that  about  two  months  before  his  return  to  him- 
self, he  began  to  have  thoughts  and  sensations ; 
these,  however,  only  served  to  convey  to  him 
fears  and  apprehensions,  especially  in  the  night 
time.  With  regard  to  his  medical  treatment,  I 
shall  only  observe,  that  the  medicines  usually  pre- 
scribed for  melancholic  persons  were  in  his  case 
studiously  avoided,  and  instead  of  evacuants,  cor- 
dials and  a  generous  diet  were  constantly  recom- 
mended. Had  the  natural  powers  been  weakened, 
I  am  satisfied  that  the  mind  never  would  have  re- 
gained her  empire.  During  the  remainder  of  his 
stay  in  the  Asylum,  he  continued  to  behave  him- 
self with  steadiness  and  propriety.  He  ate  and 
drank  moderately,  and  upon  all  occasions  showed 
a  gentle  and  benevolent  disposition.  Finding  his 
mind  sufficiently  strong,  he  returned  to  his  family 
on  the  28th  of  May,  1783.  Soon  after  this  he 
was  appointed  to  the  command  of  a  ship  employ- 
ed in  the  Baltic  trade,  in  which  service  he  is  at 
this  time  engaged." 

I  shall  dismiss  the  history  of  all  the  different 
forms  of  madness,  and  of  their  respective  reme- 
dies, by  remarking,  that  they  do  not  always  occur 


OP  THE  MIND.  235 

in  the  order  in  which  they  have  been  described. 
Partial  and  general  madness  sometimes  precede 
and  sometimes  succeed  each  other.  Manicula 
sometimes  exists  without  mania,  and  both,  with- 
out being  succeeded  by  manalgia.  There  are  in- 
stances in  which  manalgia  has  preceded  mania 
and  manicula ;  and  lastly,  we  now  and  then  see 
them  all  combine,  and  alternate  with  each  other. 
From  this  view  of  the  successive  and  alternate 
changes  of  the  different  forms  of  madness  into 
each  other,  we  derive  fresh  proofs  of  the  unity  of 
its  cause,  and  the  necessity  of  renouncing  all  pre- 
scriptions for  its  names,  and  of  constantly  and 
closely  watching  the  disease,  in  order  to  vary  our 
remedies  with  its  varying  forms. 

I  shall  now  make  a  few  remarks,  which  are  alike 
applicable  to  all  the  forms  of  general  madness. 

1.  Great  regard  should  be  had  to  cleanliness  in 
the  persons  and  apartments  of  mad  people.  This 
is  indispensably  necessary,  not  only  for  their  com- 
fort, but  their  cure.  A  deranged  man,  with  a 
ragged  dress,  a  dirty  skin,  long  nails  and  beard, 
and  uncombed  hair,  or  with  his  dress  and  person 
in  neat  order,  in  a  filthy  room,  loses  his  conscious- 
ness of  his  personal  identity ;  and  until  this  be  re- 
stored, it  is  in  vain  to  expect  a  return  of  the  na- 


236  ON  THE  DISEASES 

tural  habits  of  his  mind.  A  close  stool,  with  a 
pan  half  filled  with  water,  in  order  to  suffocate  the 
fojtor  of  his  evacuations,  should  be  fixed  in  his 
room,  with  a  cover,  which  should  fall  down  of 
itself  upon  the  stool  after  it  is  used. 

2.  Mad  people  should  never  be  visited,  nor 
even  seen  by  their  friends,  and  much  less  by  stran- 
gers, without  being  accompanied  by  their  physi- 
cian, or  by  a  person  to  whom  he  shall  depute  his 
power  over  them.  The  dread  of  being  exposed 
and  gazed  at  in  the  cell  of  a  hospital  by  an  un- 
thinking visiter,  or  an  unfeeling  mob,  is  one  of  the 
greatest  calamities  a  man  can  anticipate  in  his 
tendency  to  madness.  The  apprehension  of  it  was 
so  distressing  to  a  young  gentleman  in  this  city 
in  a  fit  of  low  spirits,  that  he  prevented  it,  by  dis- 
charging the  contents  of  a  loaded  musket  through 
his  brain.  But  there  is  another  advantage  from 
concealing  the  persons  of  mad  people  from  the 
eyes  of  visiters  and  the  public.  The  disease  is  sup- 
posed to  fix  something  of  a  repelling  nature  upon 
persons  and  families,  and  hence  it  is  often  con- 
cealed or  denied.  Now,  by  rendering  the  place 
in  which  mad  people  are  confined,  private — I  had 
almost  said  sacred — members  of  families  may  be 
sent  there  without  its  being  known.  Nay,  they 
will  be  sent  there  upon  the  first  appearance  of  the 


OP  THE  MIND. 


237 


disease,  in  order  to  prevent  its  being  known,  and 
the  disease  thereby  be  more  frequently  cured. 
This  privacy  would  act  with  peculiar  force  upon 
the  female  sex.  The  obliquity  and  convulsions  of 
the  moral  faculties,  which  sometimes  take  place 
in  madness,  would  in  this  way  never  be  known,  or 
if  known,  would  be  forgotten,  or  never  divulged. 
To  render  a  hospital  still  more  agreeable,  or  less 
the  object  of  aversion  by  the  female  sex,  they 
should  be  carefully  separated  from  the  men,  and 
they  should  be  nursed  only  by  women. 

3.  In  the  history  of  all  the  forms  of  general 
madness,  it  was  remarked  that  they  were  all  at- 
tended, now  and  then,  with  the  cheerfulness  of 
amenomania,  but  oftener  with  the  distress  of hypo- 
chondriasm.  In  the  latter  case,  it  will  be  necessa- 
ry to  use  all  the  precautions  to  prevent  suicide 
that  were  recommended  in  treating  upon  that  dis- 
ease. 

4.  We  should  be  careful  to  distinguish  between 
a  return  of  reason  and  a  certain  cunning,  which 
enables  mad  people  to  talk  and  behave  correctly 
for  a  short  time,  and  thereby  to  deceive  their  at- 
tendants, so  as  to  obtain  a  premature  discharge 
from  their  place  of  confinement.     To  prevent  the 
evils  that  might  arise  from  a  mistake  of  this  kind, 


238  ON  THE  DISEASES 

they  should  be  narrowly  watched  during  their 
convalescence,  nor  should  they  be  discharged, 
until  their  recovery  had  been  confirmed  by  weeks 
of  correct  conversation  arid  conduct.  Three  in- 
stances of  suicide  have  occurred  in  patients  soon 
after  they  left  the  Pennsylvania  Hospital,  and 
while  they  were  receiving  the  congratulations  of 
their  friends  upon  their  recovery.  The  disease, 
in  these  cases,  was  probably  revived  by  two 
causes, 

1.  By  means  of  association,  from  the  sight  of 
persons  or  objects  that  first  excited  it,  or  that 
were  first  connected  with  it ;  and, 

2.  By  exchanging  the  large  and  noisy  society 
of  the  hospital,  for  the  comparative  solitude  and 
silence  of  a  private  family. 

The  madness  of  Dr.  Zimmerman,  which  had 
been  suspended  for  three  months  by  traveling, 
returned  on  the  day  he  entered  his  own  house. 
To  prevent  this  fatal  or  distressing  recurrence  of 
madness,  it  would  be  a  good  practice  to  send  pa- 
tients abroad,  or  to  reside  for  some  time  among 
strangers,  before  they  returned  to  their  families. 
All  the  means  of  destroying  themselves,  should, 
at  the  same  time,  be  kept  out  of  their  way. 


OP  THE  MIND.  239 

The  recurrence  of  madness,  after  it  has  been 
cured,  is  no  objection  to  the  power  of  medicine 
over  it.  There  are  frequent  returns  of  catarrh, 
pleurisy,  and  intermitting  fever,  after  they  have 
been  cured,  and  yet  we  do  not  ascribe  them  to 
the  uncertainty  or  imperfection  of  our  science. 
Of  twenty-five  persons  that  were  cured  of  mad- 
ness, by  Mr.  Pinel,  but  two  relapsed  in  the  course 
of  five  years,  which  is  probably  much  less  than 
the  relapses  which  occur  from  the  other  diseases 
that  were  mentioned. 

I  can  not  conclude  this  part  of  the  subject  of 
these  Inquiries,  without  lamenting  the  want  of 
some  person  of  prudence  and  intelligence  in  all 
public  receptacles  of  mad  people,  who  should  live 
constantly  with  them,  and  have  the  exclusive  di- 
rection of  their  minds.  His  business  should  be 
to  divert  them  from  conversing  upon  all  the  sub- 
jects upon  which  they  had  been  deranged,  to  tell 
them  pleasant  stories,  to  read  to  them  select  pas- 
sages from  entertaining  books,  and  to  oblige  them 
to  read  to  him;  to  superintend  their  labours  of 
body  and  mind;  to  preside  at  the  table  at  which 
they  take  their  meals,  to  protect  them  from  rude- 
ness and  insults  from  their  keepers,  to  walk  and 
ride  with  them,  to  partake  with  them  in  their 
amusements,  and  to  regulate  the  nature  and  mea- 


240  ON  THE  DISEASES 

sure  of  their  punishments.  Such  a  person  would 
do  more  good  to  mad  people  in  one  month,  than 
the  visits,  or  the  accidental  company,  of  the  pa- 
tient's friends  would  do  in  a  year.  But  further. 
We  naturally  imitate  the  manners,  and  gradually 
acquire  the  temper  of  persons  with  whom  we  live, 
provided  they  are  objects  of  our  respect  and  af- 
fection. This  has  been  observed  in  husbands  and 
wives,  who  have  lived  long  and  happily  together, 
and  even  in  servants,  who  are  strongly  attached 
to  their  masters  and  mistresses.  Similar  effects 
might  be  expected  from  the  constant  presence  of 
a  person,  such  as  has  been  described,  with  mad 
people,  independently  of  his  performing  for  them 
any  of  the  services  that  have  been  mentioned. 
We  render  a  limb  that  has  been  broken,  and  bent, 
straight,  only  by  keeping  it  in  one  place  by  the 
pressure  of  splints  and  bandages.  In  like  man- 
ner, by  keeping  the  eyes  and  ears  of  mad  people 
under  the  constant  impressions  of  the  counten- 
ance, gestures,  and  conversation  of  a  man  of  a 
sound  understanding,  and  correct  conduct,  we 
should  create  a  pressure  nearly  as  mechanical 
upon  their  minds,  that  could  not  fail  of  having  a 
powerful  influence,  in  conjunction  with  other  re- 
medies, in  bringing  their  shattered  and  crooked 
thoughts  into  their  original  and  natural  order. 


OF  THE  MIND.  24 1 

In  reviewing  the  slender  and  inadequate  means 
that  have  been  employed  for  ameliorating  the 
condition  of  mad  people,  we  are  led  further  to 
lament  the  slower  progress  of  humanity  in  its 
efforts  to  relieve  them,  than  any  other  class  of 
the  afflicted  children  of  men.     For  many  centu- 
ries they  have  been  treated  like  criminals,  or 
shunned  like  beasts  of  prey;  or,  if  visited,  it  has 
been  only  for  the  purposes  of  inhuman  curiosity 
and  amusement.    Even  the  ties  of  consanguinity 
have  been  dissolved  by  the  walls  of  a  mad-house, 
and  sons  and  brothers  have  sometimes  languished 
or  sauntered  away  their  lives  within  them,  with- 
out once  hearing  the  accents  of  a  kindred  voice. 
Happily  these  times  of  cruelty  to  this  class  of  our 
fellow  creatures,  and  insensibility  to  their  suffer- 
ings, are  now  passing  away.     In  Great  Britain,  a 
humane  revolution,  dictated  by  modern  improve- 
ments in  the  science  of  the  mind,  as  well  as  of 
medicine,  has  taken  place  in  the  receptacles  of 
mad  people,  more  especially  in  those  that  are  of 
a  private  nature.     A  similar  change  has  taken 
place  in  the  Pennsylvania  Hospital,  under  the 
direction  of  its  present  managers,  in  the  con- 
dition of  the  deranged  subjects    of  their  care. 
The  clanking  of  chains,  and  the  noise  of  the 
whip,  are  no  longer  heard  in  their  cells.    They 
now  taste  of  the  blessings  of  air,  and  light,  and 

31 


242  ON  THE  DISEASES 

motion,  in  pleasant  and  shaded  walks  in  summer, 
and  in  spacious  entries,  warmed  by  stoves,  in 
winter,  in  both  of  which  the  sexes  are  separated, 
and  alike  protected  from  the  eye  of  the  visitors 
of  the  hospital.  In  consequence  of  these  advan- 
tages, they  have  recovered  the  human  figure, 
and,  with  it,  their  long  forgotten  relationship  to 
their  friends  and  the  public.  Much,  however, 
remains  yet  to  be  done  for  their  comfort  and  re- 
lief. To  animate  us  in  filling  up  the  measure  of 
kindness  which  has  been  solicited  for  them,  let  us 
recollect  the  greatness  of  its  object.  It  is  not  to 
feed  nor  clothe  the  body,  nor  yet  to  cure  one  of 
its  common  diseases :  it  is  to  restore  the  disjoint- 
ed or  debilitated  faculties  of  the  mind  of  a  fellow 
creature*  to  their  natural  order  and  offices,  and 

*  The  following  short  extract,  taken  down  by  Mr.  Coats, 
from  the  constant  conversation  of  a  young  man  of  a  good  edu- 
cation, and  respectable  connexions,  now  deranged  in  the  Penn- 
sylvania Hospital,  will  exhibit  an  affecting  specimen  of  this 
disjointed  state  of  the  mind,  and  of  the  incoherence  of  its  ope- 
rations. "  No  man  can  serve  two  masters.  I  am  King  Philip 
of  Macedonia,  lawful  son  of  Mary  Queen  of  Scots,  born  in 
Philadelphia.  I  have  been  happy  enough  ever  since  I  have 
seen  General  Washington  with  a  silk  handkerchief  in  High 
Street.  Money  commands  sublunary  things,  and  makes  the 
mare  go ;  it  will  buy  salt  mackerel,  made  of  ten-penny  nails. 
Enjoyment  is  the  happiness  of  virtue.  Yesterday  cannot  be 
recalled.  I  can  only  walk  in  the  night-time,  when  I  can  eat 


OF  THE  MIND.  243 

to  revive  in  him  the  knowledge  of  himself,  his 
family,  and  his  god. 

But  in  performing  this  achievement  of  skill  and 
humanity,  we  not  only  confer  a  positive  good,  but 
we  remove  a  positive  evil,  which  has  no  parallel 
in  the  list  of  human  sufferings.  If  there  were  no 
other  reason  to  believe  this  was  the  case,  than 
the  distress  which  takes  place  from  a  slight  ir- 
regularity in  the  circulation  of  the  blood  in  the 

pudding  enough.  I  shall  be  eight  years  old  to-morrow.  They 
say  R.  W.  is  in  partnership  with  J.  W.  I  believe  they  are 
about  as  good  as  people  in  common — not  better,  only  on  cer- 
tain occasions,  when,  for  instance,  a  man  wants  to  buy  chin- 
copins,  and  to  import  salt  to  feed  pigs.  Tanned  leather  was 
imported  first  by  lawyers.  Morality  with  virtue  is  like  vice 
not  corrected.  L.  B.  came  into  your  house  and  stole  a  coffee- 
pot in  the  twenty-fourth  year  of  his  majesty's  reign.  Plum- 
pudding  and  Irish  potatoes  make  a  very  good  dinner.  Nothing 
in  man  is  comprehensible  to  it.  Born  in  Philadelphia.  Our 
forefathers  were  better  to  us  than  our  children,  because  they 
were  chosen  for  their  honesty,  truth,  virtue  and  innocence. 
The  Queen's  broad  R.  originated  from  a  British  forty-two 
pounder,  which  makes  too  large  a  report  for  me.  I  have  no 
more  to  say.  I  am  thankful  I  am  no  worse  this  season,  and 
that  I  am  sound  in  mind  and  memory,  and  could  steer  a  ship 
to  sea,  but  am  afraid  of  the  thiller.  ******  *#*#**  gon  Qf 
Mary  Queen  of  Scots.  Born  in  Philadelphia.  Born  in  Phila- 
delphia. King  of  Macedonia. 


244  ON  THE  DISEASES 

brain  in  a  great  majority  of  our  dreams,  it  would 
be  sufficient  to  render  their  assertion  probable ; 
but  we  have  many  proofs  of  its  being  strictly  true. 
The  tearing  of  clothes,  so  common  in  this  dis- 
ease, was  one  of  the  instituted  signs  of  deep  dis- 
tress among  the'  Jews,  and  it  was  so  probably, 
from  its  being  one  of  its  natural  signs  among  the 
nations  of  the   East.     The  hallooing,  stamping 
with  the  feet,  and  the  rattling  of  chains,  so  gen- 
erally practised  by  mad  people,  are  all  resorted 
to,  in  order  to  excite  such  counter-impressions 
upon  their  ears,  as  shall  suspend  or  overcome,  by 
their  force,  the  anguish  of  their  minds.     They 
wound  and  mangle  their  bodies  for  the  same  pur- 
pose.    Even   in  those  solitary  cases  of  general 
madness  which  are    accompanied  with   singing 
and  laughter,  there  is  good  reason  to  believe  the 
heart  is  depressed  with  sadness.     Nor  are  the 
silence,  and  seeming  apathy  of  manalgia,  always 
signs  of  the  absence  of  misery.     The  "  willow 
weeps,"  says  the  poet,  "but  cannot  feel;  the  tor- 
pid maniac  feels,  but  cannot  weep."    In  main- 
taining the  general  existence  of  misery  in  all  the 
forms  of  derangement,  I  am  supported,  not  only 
by  the  acts  that  have  been  mentioned,  but  by  the 
authority  of  Shakspeare,  in  the  following  view  of 
the  images  and  feelings  that  usually  harrow  up 
the  imaginations  of  mad  people. 


OP  THE  MIND.  245 

"  Who  gives  any  thing  (says  Edgar)  to  poor  Tom, 

Whom  the  foul  fiend  has  led  through  fire, 

And  through  flame,  through  ford,  and  whirlpool, 

Over  bog  and  quagmire,  that  hath  laid 

Knives  under  his  pillow,  and  halters  in  his  pew, 

Set  rat's-bane  by  his  porridge,  and  made  him  to 

Ride  upon  a  bay  trotting  horse,  over  four-inch 

Bridges,  and  to  course  his  own  shadow  for  a  traitor." 

And  again,  Lear,  in  a  language  still  more  ex- 
pressive of  suffering,  complains, 


I  am  bound 


Upon  a  wheel  of  fire,  that  mine  own  tears 
Do  scald  like  molten  lead." 

It  is  no  objection  to  the  correctness  of  this  de- 
scription of  the  distress  and  horror  which  dis- 
tracts the  mind  of  mad  people,  that  they  often 
have  no  recollection  of  them  after  their  recovery. 
Happily  for  them!  this  is  prevented,  by  derange- 
ment affecting  the  memory  as  well  as  the  under- 
standing. Even  in  those  cases  of  manalgia  in 
which  the  mind  loses  its  sensibility  to  misery,  and 
the  subjects  of  it  cease  to  be  objects  of  our  sym- 
pathy, they  do  not  forfeit  their  claims  to  our  good 
offices.  Though  insensible  of  mental  pain,  they 
are  still  sensible  of  kindness,  and  of  corporeal 
pleasure.  A  pleasant  look,  a  kind  word,  an 
orange,  an  apple,  or  even  a  flower,  presented  to 


246  ON  THE  DISEASES 

them  in  an  affectionate  manner,  are  cordials  and 
donations  of  inestimable  value.  With  these  tran- 
sient and  casual  favours  should  be  united  savoury 
food.  This  is  the  more  necessary  to  them,  as 
their  senses  of  smell  and  touch,  and  often  of  hear- 
ing, are  so  much  impaired  as  to  cease  to  afford 
them  any  pleasure.  Perhaps  their  food  is  more 
enjoyed  by  them  upon  that  account. 

I  shall  now  mention  the  signs  of  a  favourable 
and  unfavourable  issue  of  madness,  in  all  the  forms 
of  it  which  have  been  described. 

The  longer  its  remote  and  predisposing  causes 
have  acted  upon  the  brain,  and  mind,  the  more 
dangerous  the  disease,  and  vice  versa. 

General  madness,  which  succeeds  tristimania, 
or  that  comes  on  gradually,  is  more  difficult  to 
cure,  than  that  which  comes  on  suddenly.  Here 
we  see  its  affinity  to  fever. 

Madness,  which  arises  from  a  hereditary  pre- 
disposition, is  said  to  be  more  difficult  to  cure, 
than  that  which  follows  a  predisposition  to  it  that 
has  been  acquired.  It  is  certainly  excited  more 
easily,  and  is  more  apt  to  recur  when  cured,  but 


OF  THE  MIND.  247 

in  general,  its  paroxysms  yield  to  medicine  as  rea- 
dily as  madness  from  an  acquired  predisposition. 

Madness  from  corporeal  causes  is  more  easily 
cured  than  from  such  as  are  mental. 

The  younger  the  subject,  the  more  easy  the  cure. 
Of  467  persons  cured  in  Bethlehem  Hospital,  be- 
tween the  years  1784  and  1794,  who  were  between 
20  and  50  years  of  age,  200  of  them  were  between 
20  and  30. 

It  is  rarely  cured  in  old  people.  Mr.  Halsam 
says,  of  31  persons  in  advanced  life,  who  were  ad- 
mitted into  Bethlehem  Hospital,  but  four  were 
cured  in  the  course  of  ten  years. 

Persons  who  have  children  are  more  difficult  to 
cure  than  those  who  are  childless. 

It  is  more  easily  cured  in  women  than  in  men. 
Mania  yields  more  readily  to  medicine  than  ma- 
nicula,  or  manalgia.  A  hundred  patients  in  mania 
in  its  furious  state,  and  the  same  number  in  its 
chronic  state,  were  selected  in  the  Bethlehem  Hos- 
pital, in  order  to  determine  their  relative  danger 
and  obstinacy.  Of  the  former  62  were  cured,  and 
of  the  latter  but  twenty-seven. 


OX  THE  DISEASES 

A  paroxysm  of  mania  succeeding  manicula,  or 
manalgia,  is  favourable. 

A  fever  succeeding  bleeding  is  favourable.  It 
shows  a  suffocated  disease  to  be  changed  into  a 
diffused  one.  A  malignant  fever,  I  remarked  for- 
merly, once  cured  a  number  of  maniacs  in  our 
hospital. 

Remissions  and  intermissions  of  violent  mental 
excitement,  are  always  favourable. 

Lucid  intervals  in  manicula  and  manalgia  are 
likewise  favourable.  They  show  that  torpor  has 
not  completely  taken  possession  of  the  brain. 

Abscesses  in  any  part  of  the  body  are  favourable. 
I  formerly  mentioned  instances  of  recoveries  which 
succeeded  them. 

A  running  from,  or  moisture  in  the  nose,  after  it 
has  been  long  dry,  is  favourable. 

Warm  and  moist  hands,  after  they  have  been  long 
cold  and  dry,  are  favourable. 

A  cessation  of  burning  in  the  feet  is  favourable. 


OP  THE  MIND.  249 

General  anasarca  is  favourable,  provided  it  has 
been  preceded  by  bleeding.  It  was  followed  by  a 
recovery  in  two  cases  in  the  Pennsylvania  Hospi- 
tal in  the  year  1811. 

The  continuance  of  hysterical  symptoms,  or 
their  revival,  after  being  long  absent,  is  always 
favourable.  The  latter  shows  the  disease  to  be 
passing  from  its  seat  in  the  blood-vessels  to  the 
nerves. 

A  moderate  degree  of  obesity  occurring  during 
a  remission  of  the  disease  is  favourable.  A 
greater  degree  of  it  is  unfavourable. 

A  return  of  one  regular  stool  daily,  and  at  an 
habitual  hour,  is  favourable. 

A  diarrhrea,  when  moderate,  is  favourable. 

Madness,  from  the  common  causes  of  fever, 
from  parturition,  and  from  strong  drink,  generally 
yield  to  the  power  of  medicine. 

Madness,  from  laesions  of  the  brain,  is  seldom 
cured. 

32 


250  ON  THE  DISEASES 

Madness  which  succeeds  epilepsy,  or  that  is 
alternated  with  it,  is,  I  believe,  always  incurable. 

Madness  which  succeeds  headach,  palsy,  and 
fatuity,  is  generally  incurable. 

Madness  from  emotions  of  the  mind,  such  as 
anger,  joy  and  terror,  is  more  easily  cured  than 
when  it  arises  from  the  passions.  From  the  for- 
mer causes  it  comes  on  suddenly,  from  the  latter 
gradually. 

Madness  is  difficult  to  cure,  when  it  arises  from 
the  revival  of  an  old  and  dormant  passion,  ex- 
cited by  association,  especially  when  that  passion 
is  love  or  grief.  It  is  remarkable,  that  the  love 
which  causes  madness,  does  not  revive  with  its 
cure. 

Gaiety,  timidity,  and  good  humour,  are  favour- 
able. Ill-temper  is  favourable. 

Weeping  is  favourable,  when  the  disease  has 
been  preceded  by  hypochondriasm.  It  shows  it 
to  be  changing  into  the  less  dangerous  and  dis- 
tressing disease  of  hysteria. 

Pensiveness  and  taciturnity  often  accompany 


OP  THE  MIND.  251 

and  succeed  a  recovery  from  this  disease.  This 
is  elegantly  described  in  Orlando  Furioso,  after 
his  recovery  from  madness  induced  by  the  un- 
faithfulness of  his  beloved  Angelica. 

Slow  recoveries  are  most  favourable. 

A  discharge  of  blood  from  the  haemorrhoidal 
vessels,  and  the  return  of  the  menses,  where  they 
have  been  obstructed,  are  always  favourable. 

In  three  cases  of  madness  that  have  occurred 
during  pregnancy,  within  my  knowledge,  parturi- 
tion did  not  cure  nor  even  mitigate  them. 

A  return  of  spelling  correctly,  after  it  had  been 
suspended,  is  favourable :  so  is  a  return  of  deli- 
cacy, more  especially  in  the  female  sex. 

The  return  of  an  habitual  disease  or  appetite, 
shows  an  abatement  of  the  violence  of  madness, 
and  is  always  favourable.  The  return  of  an  ha- 
bitual employment,  or  of  any  of  the  habits  of  the 
understanding  or  the  affections,  that  had  been 
suspended,  is  still  more  favourable.  I  shall  men- 
tion instances  of  each  of  them. 

Sir  George  Baker  declared  the  king  of  Great 


252  ON  THE  DISEASES 

Britain  to  be  convalescent  from  his  first  attack  of 
madness,  as  soon  as  he  heard  him  speak  with  a 
rapidity  that  had  always  been  natural  to  him,  and 
which  he  had  lost  during  his  insanity. 

I  attended  a  young  man  of  the  name  of  Wilki- 
son,  in  the  Pennsylvania  Hospital,  in  whom  a 
habit  of  stammering  was  suspended  during  his 
derangement,  but  which  returned  as  soon  as  he 
began  to  mend. 

The  return  of  diseases  that  are  painful,  such 
as  headach,  the  rheumatism,  the  piles,  or  cough, 
also  of  tremors,  and  cutaneous  eruptions,  is  still 
more  favourable  than  the  two  cases  of  disease 
that  have  been  mentioned. 

A  revival  of  an  appetite  for  gingerbread,  in  a 
young  man  in  our  hospital,  who  had  been  fond  of 
it  when  in  health,  was  soon  afterwards  followed 
by  his  complete  recovery. 

A  young  lady  in  the  neighbourhood  of  Phila- 
delphia, who  had  been  my  patient  for  several 
weeks  in  an  attack  of  madness  from  a  fever,  was 
observed  by  her  family  to  call  for  her  pen,  ink, 
and  common-place  book,  upon  a  Sunday.  She 
had  been  in  the  practice  of  copying  select  pieces 


OP  THE  MIND.  253 

of  poetry  into  it,  for  many  years,  upon  that  day 
of  the  week.  At  this  time  she  discovered  none 
of  the  common  signs  of  the  return  of  reason  by 
her  conduct  or  conversation.  Trifling  as  this  in- 

o 

cident  appeared,  I  encouraged  her  parents  to  ex- 
pect from  it  a  favourable  change  in  her  disease. 
It  took  place  as  I  expected,  and  she  recovered 
perfectly  in  the  course  of  a  few  weeks. 

A  female  patient  of  mine,  who  had  acquired 
pious  habits  when  a  child,  practised  them  with 
great  regularity  during  her  derangement.  Her 
recovery  was  marked  by  the  gradual  neglect  of 
her  devotion,  and  by  a  return  of  the  gay  and  dis- 
sipated practices  of  her  middle  life. 

A  Mrs.  D- ,  whom  I  supposed,  for  several 

months,  had  recovered  from  madness,  under  my 
care,  said  to  me  one  day,  in  passing  by  her  in 
our  hospital,  upon  my  asking  her  how  she  was, 
"  that  she  was  perfectly  well,  and  that  she  was 
sure  this  was  the  case,  for  that  she  had  at  last 
ceased  to  hate  me." 

A  similar  instance  of  a  perfect  recovery  suc- 
ceeding the  revival  of  domestic  respect  and  af-. 
fection,  occurred  in  a  Miss  H.  L.  who  was  con- 
fined in  our  hospital  in  the  year  1800.  For 


254  ON  THE  DISEASES 

several  weeks  she  discovered  every  mark  of  a 
sound  mind  except  one.  She  hated  her  father. 
On  a  certain  day  she  acknowledged,  with  plea- 
sure, a  return  of  her  filial  attachment  and  affec- 
tion for  him;  soon  after  she  was  discharged  cured. 

Spontaneous  recoveries  now  and  then  occur, 
after  the  disease  has  continued  18  and  20  years. 
A  recovery  after  the  former  period  has  lately 
taken  place  in  a  German  farmer,  in  the  county  of 
Montgomery,  in  this  state. 

Maniacal  patients  sometimes  die  of  its  tonic 
or  acute  state,  but  in  its  chronic  forms  they  more 
commonly  die  of  some  one  of  the  following  dis- 
eases. 

1.  Atrophy.     Dr.  Greding  says  68  out  of  100 
patients  die  of  this  wasting  disease. 

2.  Pulmonary  consumption.     It  is  remarkable 
that  this  disease  does  not  so  often  suspend  mad- 
ness, as  madness  does  pulmonary  consumption. 

3.  Dropsy,  particularly  hydrothorax  and  ana- 
sarca,  where  they  have  not  been  preceded  by 
bleeding.     The  latter  disease  aided  madness  in 
putting  an  end  to  the  miserable  life  of  Mr.  Cowper. 


OF  THE  MIND.  255 

4.  A  single  convulsive  fit,  epilepsy,  palsy,  and 
apoplexy. 

5.  Fevers. 

6.  The  disease  induced  by  fasting. 

It  has  been  remarked,  that  patients  who  have 
long  been  confined  in  mad-houses,  sometimes 
lose  their  hearing,  but  seldom  their  sight.  I  re- 
marked formerly,  that  the  ears  are  oflener  af- 
fected with  false  perceptions  than  the  eyes,  in 
mad  people;  and  from  the  nature  of  the  disease 
which  produces  those  false  perceptions,  it  is  easy 
to  conceive  that  the  sense  of  hearing  must  sooner 
perish  than  the  sense  of  sight. 

Most  of  mad  people  discover  a  greater  or  less 
degree  of  reason  in  the  last  days  or  hours  of 
their  lives.  Cervantes  therefore  discovers  both 
observation  and  judgment,  in  bringing  Don  Quix- 
ote to  his  senses  just  before  he  dies.  Thus  the 
sun,  after  a  cloudy  day,  sometimes  darts  a  few 
splendid  rays  across  the  earth  just  before  he  de- 
scends below  the  horizon.  I  have  ascribed  this 
resuscitation  of  reason  in  the  paroxysm  of  death 
to  the  diseased  blood-vessels  relieving  themselves 


256  ON  THE  DISEASES 

by  an  effusion  of  water  in  the  ventricles  of  the 
brain,  or  to  the  remains  of  the  excitement  of  the 
system,  awakened  by  fever,  or  pain,  taking  re- 
fuge in  the  mind. 


OF  THE  MIND.  257 


CHAPTER  IX. 

Of  Demence,  or  Dissociation. 

RELATED  to  intellectual  madness  is  that  dis 
ease  of  the  mind,  which  has  received  from  Mr. 
Pinel  the  name  of  DEMENCE.  The  subjects  of 
it  in  Scotland  are  said  to  "have  a  bee  in  their 
bonnets."  In  the  United  States,  we  say  they  are 
"  flighty,"  or  "  hair-brained,"  and,  sometimes,  a 
"  little  cracked."  I  have  preferred  naming  it, 
from  its  principal  symptoms,  DISSOCIATION.  It 
consists  not  in  false  perception  like  the  worst 
grade  of  madness,  but  of  an  association  of  unre- 
lated perceptions,  or  ideas,  from  the  inability  of 
the  mind  to  perform  the  operations  of  judgment 
and  reason.  The  perceptions  are  generally  ex- 
cited by  sensible  objects;  but  ideas,  collected 
together  without  order,  frequently  constitute  a 
paroxysm  of  the  disease.  It  is  always  accompa- 
nied with  great  volubility  of  speech,  or  with 
bodily  gestures,  performed  with  a  kind  of  convul- 
sive rapidity.  We  rarely  meet  with  this  disease 

33 


258  ON  THE  DISEASES 

in  hospitals ;  but  there  is  scarcely  a  city,  a  vil- 
lage, or  a  country  place,  that  does  not  furnish  one 
or  more  instances  of  it.  Persons  who  are  afflict- 
ed with  it  are  good  tempered  and  quarrelsome, 
malicious  and  kind,  generous  and  miserly,  all  in 
•  the  course  of  the  same  day.  In  a  word,  the  mind 
in  this  disease  may  be  considered  as  floating  in  a 
balloon,  and  at  the  mercy  of  every  object  and 
thought  that  acts  upon  it.  It  is  constant  in  some 
people,  but  it  occurs  more  frequently  in  parox- 
ysms, and  is  sometimes  succeeded  by  low  spirits. 
The  celebrated  Lavater  was  afflicted  with  it ;  and 
although  he  wrote  with  order,  yet  his  conversation 
was  a  mass  of  unconnected  ideas,  accompanied 
with  bodily  gestures,  which  indicated  a  degree  of 
madness.  I  shall  insert  an  account  of  a  visit  paid 
to  him  at  Zurich  by  the  Rev.  Dr.  Hunter,  an  Eng- 
lish clergyman,  in  which  he  exemplified  the  state 
of  mind  I  wish  to  describe. 

"  I  was  detained,"  says  he,  "  the  whole  morn- 
ing by  the  strange,  wild,  eccentric  Lavater,  in 
various  conversations.  When  once  he  is  set  a 
going  there  is  no  such  thing  as  stopping  him  till 
he  runs  himself  out  of  breath.  He  starts  from 
subject  to  subject,  flies  from  book  to  book,  from 
picture  to  picture ;  measures  your  nose,  your  eye, 
your  mouth,  with  a  pair  of  compasses;  pours 


OP  THE  MIND.  259 

forth  a  torrent  of  physiognomy  upon  you ;  drags 
you,  for  a  proof  of  his  dogma,  to  a  dozen  of  clo- 
sets, and  unfolds  ten  thousand  drawings ;  but  will 
not  let  you  open  your  lips  to  propose  a  difficulty ; 
crams  a  solution  down  your  throat,  before  you 
have  uttered  half  a  syllable  of  your  objection. 

"  He  is  as  meagre  as  the  picture  of  famine ;  his 
nose  and  chin  almost  meet.  I  read  him  in  my 
turn,  and  found  little  difficulty  in  discovering, 
amidst  great  genius,  unaffected  piety,  unbounded 
benevolence  and  moderate  learning,  much  caprice 
and  unsteadiness;  a  mind  at  once  aspiring  by 
nature,  and  groveling  through  necessity;  an  end- 
less turn  to  speculation  and  project ;  in  a  word,  a 
clever,  flighty,  good  natured,  necessitous  man." 

I  said  formerly,  that  hysteria  consisted  in  mo- 
bility of  the  nervous  and  muscular  system.  Dis- 
sociation seems  to  be  occasioned  by  a  similar 
mobility  of  that  part  of  the  brain  which  is  the  seat 
of  the  mind. 

The  remedies  for  it,  when  it  is  attended  with 
great  excitement,  as  it  generally  is,  should  be, 
bleeding,  low  diet,  purges,  and  all  the  other  reme- 
dies for  reducing  morbid  excitement  in  the  brain, 


260  ON  THE  DISEASES 

recommended  formerly  for  the  cure  of  intellectual 
madness. 

When  the  disease  is  periodical,  bark,  and  other 
tonics,  should  be  given  in  its  intervals. 


OP  THE  MIND.  261 


CHAPTER  X. 


On  Derangement  in  the  Will. 

Two  opinions  have  divided  philosophers  and 
divines  upon  the  subject  of  the  operations  of  the 
will.  It  has  been  supposed  by  one  sect  of  each 
of  them  to  act  freely ;  and  by  the  others  to  act 
from  necessity,  and  only  in  consequence  of  the 
stimulus  of  motives  upon  it.  Both  these  opinions 
are  supported  by  an  equal  weight  of  arguments ; 
and  however  incomprehensible  the  union  of  two 
such  opposite  qualities  may  appear  in  the  same 
function,  both  opinions  appear  to  be  alike  true. 

The  will  is  affected  by  disease  in  two  ways. 

I.  When  it  acts  without  a  motive,  by  a  kind  of 
involuntary  power.  Exactly  the  same  thing  takes 
place  in  this  disease  of  the  will,  that  occurs  when 
the  arm  or  foot  is  moved  convulsively  without 


262  ON  THE  DISEASES 

an  act  of  the  will,  and  even  in  spite  of  it.  The 
understanding,  in  this  convulsed  state  of  the  will, 
is  in  a  sound  state,  and  all  its  operations  are  per- 
formed in  a  regular  manner.  When  the  will  be- 
comes the  involuntary  vehicle  of  vicious  actions, 
through  the  instrumentality  of  the  passions,  I 
have  called  it  MORAL  DERANGEMENT.  For  a  more 
particular  account  of  this  moral  disease  in  the 
will,  the  reader  is  again  referred  to  a  printed  lec- 
ture, delivered  by  the  author  in  the  University  of 
Pennsylvania,  in  November,  1810,  upon  the  study 
of  Medical  Jurisprudence,  in  which  the  morbid 
operations  of  the  will  are  confined  to  two  acts, 
viz.  murder  and  theft.  I  have  selected  those  two 
symptoms  of  this  disease  (for  they  are  not  vices) 
from  its  other  morbid  effects,  in  order  to  rescue 
persons  affected  with  them  from  the  arm  of  the 
law,  and  to  render  them  the  subjects  of  the  kind 
and  lenient  hand  of  medicine.  But  there  are 
several  other  ways,  in  which  this  disease  in  the 
will  discovers  itself,  that  are  not  cognizable  by 
law.  I  shall  describe  but  two  of  them.  These 
are,  LYING  and  DRINKING. 

1.  There  are  many  instances  of  persons  of  sound 
understandings,  and  some  of  uncommon  talents, 
who  are  affected  with  this  LYING  disease  in  the 
will.  It  differs  from  exculpative,  fraudulent  and 


OP  THE  MIND.  263 

malicious  lying,  in  being  influenced  by  none  of  the 
motives  of  any  of  them.  Persons  thus  diseased 
can  not  speak  the  truth  upon  any  subject  nor  tell 
the  same  story  twice  in  the  same  way,  nor  describe 
any  thing  as  it  has  appeared  to  other  people. 
Their  falsehoods  are  seldom  calculated  to  injure 
any  body  but  themselves,  being  for  the  most  part 
of  a  hyperbolical  or  boasting  nature,  but  now  and 
then  they  are  of  a  mischievous  nature,  and  injuri- 
ous to  the  characters  and  property  of  others. 
That  it  is  a  corporeal  disease,  I  infer  from  its 
semetimes  appearing  in  mad  people,  who  are  re- 
markable for  veracity  in  the  healthy  states  of  their 
minds,  several  instances  of  which  I  have  known  in 
the  Pennsylvania  Hospital.  Persons  affected  with 
this  disease  are  often  amiable  in  their  tempers  and 
manners,  and  sometimes  benevolent  and  charita- 
ble in  their  dispositions. 

Lying,  as  a  vice,  is  said  to  be  incurable.  The 
same  thing  may  be  said  of  it  as  a  disease,  when  it 
appears  in  adult  life.  It  is  generally  the  result  of 
a  defective  education.  It  is  voluntary  in  child- 
hood, and  becomes  involuntary,  like  certain  mus- 
cular actions,  from  habit.  Its  only  REMEDY,  is, 
bodily  pain,  inflicted  by  the  rod,  or  confinement, 


264  ON  THE  DISEASES 

or  abstinence  from  food ;  for  children  are  incapa- 
ble of  being  permanently  influenced  by  appeals  to 
reason,  natural  affection,  gratitude,  or  even  a 
sense  of  shame. 

2.  The  use  of  strong  drink  is  at  first  the  effect 
of  free  agency.  From  habit  it  takes  place  from 
necessity.  That  this  is  the  case,  I  infer  from  per- 
sons who  are  inordinately  devoted  to  the  use  of 
ardent  spirits  being  irreclaimable,  by  all  the  con- 
siderations which  domestic  obligations,  friend- 
ships, reputation,  property,  and  sometimes  even 
by  those  which  religion  and  the  love  of  life,  can 
suggest  to  them.  An  instance  of  insensibility  to 
the  last,  in  an  habitual  drunkard,  occurred  some 
years  ago  in  Philadelphia.  When  strongly  urged, 
by  one  of  his  friends,  to  leave  off  drinking,  he  said, 
"  Were  a  keg  of  rum  in  one  corner  of  a  room,  and 
were  a  cannon  constantly  discharging  balls  be- 
tween me  and  it,  I  could  not  refrain  from  passing 
before  that  cannon,  in  order  to  get  at  the  rum." 

The  REMEDIES  for  this  disease  have  hitherto 
been  religious  and  moral,  and  they  have  some- 
times cured  it.  They  would  probably  have  been 
more  successful,  had  they  been  combined  with 


OP  THE  MIND.  265 


such  as  are  of  a  physical  nature.  For  an  account 
of  several  of  them,  the  reader  is  referred  to  the 
first  volume  of  the  author's  Medical  Inquiries  and 
Observations.     To  that  account  of  physical  reme- 
dies I  shall  add  one  more,  and  that  is,  the  esta- 
blishment of  a  hospital  in  every  city  and  town  in 
the  United  States,  for  the  exclusive  reception  of 
hard  drinkers.     They  are  as  much  objects  of 
public   humanity  and  charity,  as  mad    people. 
They  are  indeed  more  hurtful  to  society,  than 
most  of  the  deranged  patients  of  a  common  hos- 
pital would  be,  if  they  were  set  at  liberty.     Who 
can  calculate  the  extensive  influence  of  a  drunken 
husband  or  wife  upon  the  property  and  morals  of 
their  families,  and  of  the  waste  of  the  former,  and 
corruption  of  the  latter,  upon  the  order  and  hap- 
piness of  society?     Let  it  not  be  said,  that  con- 
fining such  persons  in  a  hospital  would  be  an 
infringement  upon  personal  liberty,  incompatible 
with  the  freedom  of  our  governments.     We  do 
not  use  this  argument  when  we  confine  a  thief  in 
a  jail,  and  yet,  taking  the  aggregate  evil  of  the 
greater  number  of  drunkards  than  thieves  into 
consideration,  and  the  greater  evils  which  the 
influence  of  their  immoral  example  and  conduct 
introduce  into  society  than  stealing,  it  must  be 
obvious,  that  the  safety  and  prosperity  of  a  com- 

34 


266  ON  THE  DISEASES 

munity  will  be  more  promoted  by  confining  them, 
than  a  common  thief.  To  prevent  injustice  or 
oppression,  no  person  should  be  sent  to  the  con- 
templated hospital,  or  SOBER  HOUSE,  without  being 
examined  and  committed  by  a  court,  consisting 
of  a  physician,  and  two  or  three  magistrates,  or 
commissioners  appointed  for  that  purpose.  If  the 
patient  possess  property,  it  should  be  put  into  the 
hands  of  trustees  to  take  care  of  it.  Within  this 
house  the  patient  should  be  debarred  the  use  of 
ardent  spirits,  and  drink  only,  for  a  while,  such 
substitutes  for  them,  as  a  physician  should  direct. 
Tobacco,  one  of  the  provocatives  of  intemper- 
ance in  drinking,  should  likewise  be  gradually 
abstracted  from  them.  Their  food  should  be 
simple,  but  for  a  while  moderately  cordial.  They 
should  be  employed  in  their  former  respective 
occupations,  for  their  own,  or  for  the  public 
benefit,  and  all  the  religious,  moral,  and  physical 
remedies,  to  which  I  have  referred,  should  be  em- 
ployed at  the  same  time,  for  the  complete  and 

radical  cure  of  their  disease. 

f 

2.  Besides  the  disease  in  the  will,  which  has 
been  described,  it  is  subject  to  such  a  degree  of 
debility  and  torpor,  as  to  lose  all  sensibility  to  the 
stimulus  of  motives,  and  to  become  incapable  of 


OP  THE  MIND.  267 

acting  either  freely  or  from  necessity.    In  this 
respect  it  resembles  a  paralytic  limb.    We  some- 
times say  of  persons  who  are  governed  by  their 
friends,  or  a  favourite,  that  « they  have  no  will 
of  their  own."    This  is  strictly  true.     If  left  to 
themselves,  they  would  neither  buy  nor  sell,  nor 
transact  any  kind  of  business.     They  will,  and 
prefer  nothing,  and  they  do  nothing,  but  what  is 
closely  connected  with  their  animal  existence.   It 
is  from  the  habitual  want  of  exercise  in  the  will 
in  slaves,  that  it  is  so  apt  to  acquire  this  paralytic 
state;  and  it  is  because  we  are  deprived  of  its 
co-operation  with  our  medicines  in  the  desire  of 
life,  that  we  are  less  successful  in  curing  their 
diseases  under  equal  circumstances,  than  the  dis- 
eases of  freemen.     Animal  magnetism,  Mr.  Bris- 
set  informed  me,  performed  many  cures  of  light 
diseases,  upon  the  white  people  in  the  West  In- 
dies, but  not  a  single  slave  was  benefited  by  it, 
and  probably  from  the  cause  that  has  been  men- 
tioned. 

I  have  never  been  consulted  in  this  disease  of 
the  will,  but  I  have  no  doubt  stimulating  and  tonic 
remedies,  preceded  by  depletion,  would  be  useful 
in  it.     Persons  afflicted  with  this  disorder  of  the 
mind  should  be  placed  in  situations,  in  which  they 


268  ON  THE  DISEASES 

will  be  compelled  to  use  their  wills,  in  order  to 
escape  some  great  and  pressing  evil.  A  palsy  of 
the  limbs  has  been  cured  by  the  cry  of  fire,  and 
a  dread  of  being  burned.  Why  should  not  a 
palsy  of  the  will  be  cured  in  a  similar  way? 


OF    THE    MIND.  269 


CHAPTER  XL 

Of  Derangement  in  the  Principle  of  Faith>  or  the 
Believing  Faculty. 

As  this  faculty  has  not  yet  found  its  way  into 
our  systems  of  physiology,  I  shall  briefly  remark, 
that  I  mean  by  it  that  principle  in  the  mind,  by 
which  we  believe  in  the  evidence  of  the  senses, 
of  reason,  and  human  testimony.  It  is  as  much 
a  native  faculty  as  memory  or  imagination.  The 
objects  of  human  testimony  are  extensive  and 
important.  Saint  Paul  alludes  to  them  in  the 
following  passage  of  the  eleventh  chapter  of  his 
Epistle  to  the  Hebrews.  "  Through  faith  we  un- 
derstand that  the  worlds  were  framed  by  the  word 
of  God,  so  that  things  which  are  seen  were  not 
made  of  things  which  do  appear."  The  greatest 
part  of  all  we  believe  of  history,  geography,  and 
public  events,  and  all  that  we  believe  of  our  rela- 
tion to  our  parents,  brothers,  and  sisters,  by  the 
tics  of  consanguinity,  are  derived  from  it.  Hap- 


270  ON  THE  DISEASES 

pily  for  us !  its  operations  are  involuntary  in  its 
sound  state.  Happily  for  us,  likewise !  a  source 
of  knowledge,  so  necessary  to  individual  comfort 
and  social  existence,  has  not  been  made  depend- 
ant upon  our  senses,  nor  left  to  the  slow  induc- 
tions of  reason.  The  world  could  not  exist  in  its 
present  circumstances  without  it.  It  is  no  objec- 
tion to  its  necessity  and  usefulness,  that  we  are 
sometimes  deceived  by  it.  The  same  objection 
applies  with  equal  force  to  our  senses  and  reason, 
as  sources  of  knowledge. 

Persons  affected  with  this  disease  in  the  prin- 
ciple of  faith,  as  far  as  relates  to  human  testi- 
mony, believe  and  report  every  thing  they  hear. 
They  are  incapable  of  comparing  dates  and  cir- 
cumstances, and  tell  stories  of  the  most  improba- 
ble and  incongruous  nature.  Sometimes  they 
propagate  stories  that  are  probable,  but  false; 
and  thus  deceive  their  friends  and  the  public. 
There  is  scarcely  a  village  or  city  that  does  not 
contain  one  or  more  persons  affected  with  this 
disease.  Horace  describes  a  man  of  that  cha- 
racter in  Rome,  of  the  name  of  Apella.  The  pre- 
disposition of  such  persons  to  believe  what  is 
neither  true,  nor  probable,  is  often  sported  with 
by  their  acquaintances,  by  which  means  their  sto- 
ries often  gain  a  currency  through  whole  com- 
munities. 


, 

OP  THE  MIND.  271 

It  is  probable  the  confinement  of  persons  af- 
flicted with  this  malady,  immediately  after  they 
hear  any  thing  new,  might  cure  them.  Perhaps 
ridicule  might  assist  this  remedy.  I  think  I  once 
saw  it  effectual  in -an  old  quidnunc  during  the 
revolutionary  war. 

This  faculty  of  the  mind  is  subject  to  disorder 
as  well  as  to  disease ;  that  is,  to  an  inability  to  be- 
lieve things  that  are  supported  by  all  the  evidence 
that  usually  enforces  belief.  Mr.  Burke  has  de- 
scribed the  conduct  of  persons  affected  with  the 
disorder  in  the  following  words :  "  They  believe 
nothing  that  they  do  not  see,  or  hear,  or  measure 
by  a  twelve  inch  rule."  An  Indian  once  express- 
ed the  state  of  mind  in  which  this  torpor  in  the 
principle  of  faith  takes  place,  by  saying,  when  a 
truth  was  proposed  to  his  belief,  "  that  it  would 
not  believe  for  him."  This  incredulity  is  not  con- 
fined to  human  testimony.  It  extends  to  the  evi- 
dence of  reason,  and  (it  has  been  said)  of  the 
senses.  The  followers  of  Dr.  Berkley  either  felt, 
or  affected,  the  last  grade  of  this  disorder  in  the 
principle  of  faith.  That  it  is  often  affected,  I 
infer  from  persons  who  deny  their  belief  in  the 
utility  of  medicine,  as  practised  by  regular  bred 
physicians,  believing  implicitly  in  quacks;  also 


272  ON  THE  DISEASES 

from  persons  who  refuse  to  admit  human  testi- 
mony in  favour  of  the  truths  of  the  Christian  reli- 
gion, believing  in  all  the  events  of  profane  history; 
and,  lastly,  from  persons  who  contradict  the  evi- 
dence of  their  senses  in  favour  of  matter,  being  as 
much  afraid  of  bodily  pain  from  material  or  sen- 
sible causes  as  other  people. 

The  remedy  for  this  palsy  of  the  believing 
faculty,  should  consist  in  proposing  propositions 
of  the  most  simple  nature  to  the  mind,  and,  after 
gaining  the  assent  to  them,  to  rise  to  propositions 
of  a  more  difficult  nature.  The  powers  of  oratory 
sometimes  awaken  the  torpor  of  the  principle  of 
faith.  This  was  evinced,  in  a  remarkable  manner, 
in  the  speech  which  king  Agrippa  made  to  St. 
Paul,  after  he  had  heard  his  eloquent  oration  in 
favour  of  Christianity :  "  almost  thou  persuadest 
me  to  be  a  Christian."  Perhaps  great  bodily 
pain  would  have  the  same,  or  a  greater  effect  in 
curing  this  disorder  of  the  mind.  It  has  often 
cured  paralytic  affections  of  the  body,  and  of 
other  faculties  of  the  mind. 

Sometimes  a  strong  passion,  or  emotion,  by 
preoccupying  the  mind,  prevents  the  exercise  of 
belief.  Thus  we  read,  that  the  disciples  of  our 


OF  THE  MIND.  273 

Saviour  could  not  believe  the  news  of  his  resur- 
rection, "for  joys."  In  such  cases  the  predomi- 
nating passion,  or  emotion,  should  be  abstracted, 
or  weakened  before  an  appeal  is  made  to  the 
principle  of  faith. 


35 


274  ON  THE  DISEASES 


CHAPTER  XII. 


Of  Derangement  in  the  Memory. 

THIS  disease  is  attended  with  the  following 
grades : 

1.  There  is  an  oblivion  of  names,  and  voca- 
bles of  all  kinds. 

2.  There  is  an  oblivion  of  names  and  vocables, 
and  a  substitution  of  a  word  no  ways  related  to 
them.     Thus  I  knew  a  gentleman,  afflicted  with 
this  disease,  who,  in  calling  for  a  knife,  asked  for 
a  bushel  of  wheat. 

3.  There  is  an  oblivion  of  the  name  of  sub- 
stances in  a  vernacular  language,  and  a  facility  of 
calling  them  by  their  proper  names  in  a  dead,  or 
foreign  language.     Of  this  Wepfer  relates  three 
instances.     They  were  all  Germans,  and  yet  they 
called  the  objects   around  them  only  by  Latin 


OP  THE  MIND.  275 

names.  Dr.  Johnson,  when  dying,  forgot  the 
words  of  the  Lord's  prayer  in  English,  but  at- 
tempted to  repeat  them  in  Latin.  Delirious  per- 
sons from  this  disease  in  the  memory  often  ad- 
dress their  physicians  in  Latin,  or  in  a  foreign 
language. 

4.  There  is  an  oblivion  of  all  foreign  and  ac- 
quired languages,  and  a  recollection  only  of  a 
vernacular  language.    Dr.  Scandella,   an   inge- 
nious Italian,  who  visited  this  country  a  few  years 
ago,  was  master  of  the  Italian,  French,  and  Eng- 
lish languages.     In  the  beginning  of  the  yellow 
fever,  which  terminated  his  life  in  the  city  of  New 
York,  in  the  autumn  of  1798,  he  spoke  English 
only;  in  the  middle  of  his  disease,  he  spoke 
French  only;   but  on  the  day  of  his  death,  he 
spoke  only  in  the  language  of  his  native  country. 

5.  There  is  an  oblivion  of  the  sound  of  words, 
but  not  of  the  letters  which  compose  them.     I 
have  heard  of  a  clergyman  in  Newburyport,  who, 
in  conversing  with   his  neighbours,  made  it  a 
practice  to  spell  every  word  that  he  employed  to 
convey  his  ideas  to  them. 

6.  There  is  an  oblivion  of  the  mode  of  spelling 
the  most  familiar  words.     I  once  met  with  it  as  a 


276  ON  THE  DISEASES 

premonitory  symptom  of  palsy.  It  occurs  in  old 
people,  and  extends  to  an  inability,  in  some  in- 
stances, to  remember  any  more  of  their  names 
than  their  initial  letters.  I  once  saw  a  will  sub- 
scribed in  this  manner,  by  a  man  in  the  eightieth 
year  of  his  age,  who,  during  his  life,  always  wrote 
a  neat  and  legible  hand. 

7.  There  is  an  oblivion  of  the  qualities  or  num- 
bers of  the  most  familiar  objects.    I  know  a  man 
in  this  city,  who  has  never  been  able  to  remem- 
ber the  difference  between  a  jug  and  a  pitcher; 
and  I  know  a  physician  who  for  many  years  could 
not  recollect  that  the  umbilical  cord  consisted  of 
two  arteries  and  one  vein,  without  associating  the 
former  with  the  double  a  in  the  last,  syllable  of 
the  name  of  Dr.  Boerhaave. 

There  appears  to  be  something  like  a  palsy  in 
the  memory  quoad  these  specific  objects. 

8.  There  is  an  oblivion  of  events,  time  and 
place,  with  a  perfect  recollection  of  persons  and 
names.    This  is  the  case  with  the  Rev.  Dr.  Ma- 
gaw,  formerly  minister  of  St.  Paul's  church,  in 
this  city.    This  disease  in  his  memory  was  in- 
duced by  a  paralytic  affection. 


' 

OF  THE  MIND.  277 

9.  There  is  an  oblivion  of  names  and  ideas, 
but  not  of  numbers.     We  had  a  citizen  of  Phila- 
delphia, many  years  ago,  who,  in  consequence  of 
a  slight  paralytic  disease,  forgot  the  names  of  all 
his  friends,  but  could  designate  them  correctly  by 
mentioning  their  ages,  with  which  he  had  pre- 
viously made  himself  acquainted. 

10.  However  strange  it  may  appear,  it  has 
been  remarked,  that  there  is  sometimes  an  obli- 
vion of  the  most  recent,  the  most  important-,  and  the 
most  interesting  events.     Of  this  I  could  mention 
several  instances  that  have  come  within  my  own 
knowledge.     One  of  them  occurred  to  Dr.  Priest- 
ley.    I  have  ascribed  the  oblivion  of  such  events, 
to  the  memory  being  over  stimulated  from  an  un- 
due effort  to  retain  them.     Something  similar  to 
it  occurs  in  the  inability  of  lovers  to  dream  of 
each  other. 

The  objects  of  knowledge  either  perish,  or 
sleep,  only  in  the  mind.  In  the  latter  case,  they 
are  revived  by  means  to  be  mentioned  presently. 

Wepfer  takes  notice  of  the  following  symp- 
toms occurring  with  the  loss  or  suspension  of 
memory. 


278  ON  THE  DISEASES 

A  sense  of  pain  or  heaviness  in  the  forehead,  a 
disposition  to  rub  it  with  the  hand,  a  formication, 
that  is,  a  sense  of  something  creeping  up  the  left 
arm,  and  the  fingers  of  both  hands,  a  disposition 
to  weep,  and  an  involuntary  flow  of  urine. 

The  causes  of  the  weakness  and  loss  of  memory 
are  corporeal  and  mental.     To  the  first  belong, 

1.  Intemperance  in  eating.  Suetonius  tells  us, 
the  Roman  emperor  Claudius  lost  his  memory  so 
entirely  from  this  cause,  that  he  not  only  forgot 
the  names  and  persons  to  whom  he  wished  to 
speak,  but  even  what  he  wished  to  say  to  them. 

2.  Intemperance  in  drinking.     It  was  from  the 
effect  of  strong  drink,  in  weakening  or  destroying 
the  memory,  that  an  old  Spanish  law  refused  to 
admit  any  person  to  be  a  witness  in  court  that 
had  been  convicted  of  drunkenness. 

3.  Excess  in  venery. 

4.  Fevers,  particularly  such  as  are  of  a  malig- 
nant nature,  or  that  affect  the  brain.     The  Rev. 
Wm.  Tennent,  formerly  the  pastor  of  a  Presbyte- 
rian church  at  Freehold,  in  New  Jersey,  forgot 
every  thing  he  had  learned,  even  the  letters  of  the 


OF  THE  MIND.  279 

alphabet,  in  consequence  of  an  attack  of  a  fever 
when  he  was  about  eighteen  years  of  age. 

5.  Vertigo,  epilepsy,  palsy  and  apoplexy. 

6.  Drying  up  an  issue.    Lsesions  of  the  brain. 

7.  The  use  of  snuff.    It  was  induced  by  this 
cause  in  Sir  John  Pringle. 

II.  The  mental  causes  are, 

1.  Grief.  I  once  met  with  a  woman,  who  had 
recently  lost  her  husband  and  several  children, 
who  told  me  she  forgot,  at  times,  even  her  own 
name. 

2.  Terror.    Artemidorus,  a  celebrated  gram- 
marian, was  so  terrified  with  the  sight  of  a  croco- 
dile, that  he  immediately  lost  all  the  knowledge 
that  he  had  treasured  up  in  his  memory  in  the 
course  of  his  life. 

3.  Oppressing  the  memory  in  early  life  with 
words  and  studies  disproportioned  to  its  srtength. 
The  Latin  and  Greek  languages,  and  the  prema- 
ture application  of  the  mind  to  mathematics,  I 


280 


ON  THE  DISEASES 


believe,  have  weakened  or  destroyed  not  only 
memory,  but  even  intellect,  in  many  young  minds. 

4.  The  undue  exercise  of  the  memory  upon  any 
one  subject  often  weakens  it  upon  all  others.  The 
famous  African  calculator,  Thomas  Fuller,  of  Vir- 
ginia, whose  memory  was  exercised  exclusively 
upon  numbers,  had  so  little  recollection  of  faces, 
that  he  was  unable  to  recognise  the  persons  who 
had  spent  hours  in  conversing  with  him,  and  list- 
ening to  his  calculations,  the  next  day  after  he  saw 
them.     Overcharging  the  memory  with  words  has 
the  same  effect.     A  celebrated  player  in  London, 
his  son  informed  me,  lost  the  recollection  of  the 
names  of  all  his  children  from  this  cause. 

5.  Neglecting  to  exercise  the  memory. 

6.  Cessation  from  study.    Sir  Isaac  Newton 
forgot  the  contents  of  his  "  Principia,"  by  ceas- 
ing to  exercise  his  mind  in  study. 

The  famous  Mr.  Hude  had  spent  several  years 
in  close  application  to  conic  sections.  Leibnitz, 
in  returning  from  his  travels  called  to  see  him, 
and  expected  to  have  been  highly  entertained  by 
conversing  with  him  upon  the  subject  of  his  stu- 


OF  THE  MIND.  281 

dies.  "Here,"  said  Mr.  Hude,  sighing,  "look 
over  this  manuscript.  I  have  forgotten  every 
thing  in  it  since  I  became  burgomaster  of  Amster- 
dam." 

The  remedies  for  this  disease  are  corporeal 
and  mental. 

To  the  First,  or  corporeal  remedies,  belong, 

1.  Abstracting  all  its  exciting  causes.     Sir  John 
Pringle's  memory  was  restored,  in  a  great  degree, 
by  leaving  off  the  use  of  snuff. 

2.  Depleting  remedies,  if  plethora  attend,  and 
the  pulse  be  tense  or  oppressed.     These  should 
be  bleeding,  purges,  and  low  diet.     After  the  re- 
duction of  the  system,  the  remedies  should  be, 

3.  Blisters.    Wepfer  speaks  in  high  terms  of 
their  efficacy,  when  applied  to  the  elbows  and 
calves  of  the  legs,  in  this  disease. 

4.  Issues  in  the  arms. 

5.  Errhmes. 

36 


282  ON  THE  DISEASES 

6.  Certain  aromatic  medicines.    Etmuller  says, 
when  a  young  man,  he  greatly  improved  his  me- 
mory by  swallowing  three  or  four  cubebs  every 
day.     The  cardamon  seeds  are  said  to  have  the 
same  effect.     Lavender  and  rosemary,  or  cloves, 
may  be  substituted  for  both  of  them. 

7.  The  cold  bath  and  cold  weather.    Milton's 
memory  was  always  improved  by  the  latter. 

8.  EXERCISE.     Mr.  Pope  commends  a  trotting 
horse  above  all  things,  in  order  to  excite  dormant 
ideas.     It  is  from  the  motion  excited  in  the  brain, 
by  means  of  a  fever,  that  persons,  in  that  disease, 
often  recollect  events  and  speak  languages,  which 
appeared  to  have  perished  in  their  memories. — 
The  late  Mr.  Frederic  A.  Muhleriberg  informed 
me  that  his  father,  who  was  for  many  years  minis- 
ter of  the  Lutheran  church  in  Philadelphia,  in 
visiting  the  old  Swedes,  who  inhabited  the  south- 
ern district  of  the  city,  upon  their  death  beds,  was 
much  struck  in  hearing  some  of  them  pray  in  the 
Swedish  language,  who,  he  was  sure,  had  not 
spoken  it  for  50  or  60  years  before,  and  who  had 
probably  entirely  forgotten  it.     It  was  revived  by 
the  stimulus  of  the  fever  in  their  brains  which  at- 


OP  THE  MIND.  283 

tended  the  close  of  their  lives.  The  Rev.  Dr. 
Muhlenberg  of  Lancaster,  has  furnished  me  with 
a  fact  from  his  own  observation,  similar  to  that 
which  was  communicated  to  me  by  his  brother, 
in  the  following  extract  of  a  letter  which  I  lately 
received  from  him.  "  That  people  generally 
pray  in  their  last  hours  in  their  native  language, 
is  a  fact  which  I  have  found  true,  in  innumerable 
cases,  amongst  my  German  hearers,  although 
hardly  one  word  of  German  was  spoken  by  them 
in  common  life  and  in  days  of  health."  Dr. 
Hutchinson,  in  his  Biographia  Medica,  relates  an 
anecdote  of  a  physician  of  the  name  of  Connor, 
who  had  renounced  the  principles  of  the  church 
of  Rome  in  early  life,  who,  in  the  delirium  of  a 
fever  which  preceded  his  death,  prayed  only  in 
the  forms  of  that  church.  His  fever  had  excited 
those  forms,  while  those  of  the  protestant  reli- 
gion, which  he  had  embraced,  were  obliterated 
by  the  same  fever  from  his  mind. 

• 
In  some  cases,  time  performs  a  cure  of  the  loss 

of  memory.  This  oftenest  occurs,  when  it  has 
been  induced  by  a  fever.  I  have  known  one  in- 
stance of  it,  and  have  heard  of  several  others. 
One  of  the  latter  was  in  the  Rev.  Mr.  Tennent, 
whose  name  was  just  now  mentioned,  who  stand- 


284  ON  THE  DISEASES 

ing  one  day,  at  the  feet  of  his  master,  suddenly 
threw  down  his  grammar,  and  called  for  one  of 
the  Latin  Classics,  which  he  had  begun  to  read 
previously  to  the  attack  of  his  fever.  At  that  in- 
stant all  that  he  had  ever  learned  before,  revived 
in  his  mind.  The  fever  which  deprived  him  of 
his  memory  was  attended  with  apparent  death 
for  two  or  three  days. 

II.  The  mental  remedies  for  the  loss,  or  decay 
of  memory,  should  be, 

1.  Frequently  repeating  what  we  wish  to  re- 
member.    The  benefits  of  repetition  are  strik- 
ingly illustrated  in  the  history  of  a  printer  in  Lon- 
don, who,  after  working    seven  years  in  com- 
posing the  Bible,  was  able  to  repeat  every  chap- 
ter and  verse  in  it  by  memory.     We  see  the  ad- 
vantages of  this  mode  of  strengthening  the  me- 
mory, in  persons  who  repeat  questions  or  whole 
sentences  that  are  proposed  to  them,  before  they 
can  answer  them.     The  door  of  the  mind  in  such 
people  requires   two  knocks   before  it  can  be 
opened,  one  by  the  person  who  asks,  the  other  by 
the  person  who   answers  the  questions,-  or,  to 
speak  more  simply,  the  mind  requires  a  double 
impression  from  words,  before  it  is  able  to  con- 
vert them  into  thoughts. 


OP  THE  MIND.  285 

2.  Calling  in  the  aid  of  two  or  more  of  the 
senses,  to  assist  in  the  retention  of  knowledge. 
We  seldom  forget  what  we  have  handled,  or  tast- 
ed, as  well  as  seen  or  heard.  It  is  for  this  reason 
that  physicians,  who  are  educated  in  an  apothe- 
cary's shop,  never  forget  the  sensible  qualities  or 
doses  of  medicines.  The  eyes  assist  the  ears, 
and  the  ears  the  eyes.  We  are  seldom  satisfied 
in  hearing  a  newspaper  read ;  hence,  when  it  is 
thrown  down,  we  take  it  up,  and  convey  to  our 
minds,  through  the  medium  of  our  own  eyes,  the 
facts  we  have  just  before  heard.  Children  and 
the  vulgar,  whose  memories  are  alike  weak,  are 
unable  to  retain  what  they  read,  unless  they  re- 
ceive it  at  the  same  time  through  their  eyes  and 
ears :  hence  the  practice  by  both  of  them  of  read- 
ing when  alone,  with  an  audible  voice.  In  some 
cases  they  are  unable  to  remember  even  their  own 
thoughts  without  rendering  them  audible,  hence 
we  so  often  hear  them  talking  to  themselves.  We 
observe  the  same  thing  in  the  low  and  chronic 
state  of  madness,  and  in  part  from  the  same  cause. 
Where  the  eyes  and  ears  cannot  both  be  employ- 
ed in  acquiring  knowledge,  the  use  of  the  ears 
should  be  preferred.  Julius  Csssar  says  the  rea- 
son why  the  ancient  Druids  did  not  commit  their 
instructions  to  writing,  was,  that  their  pupils 
might,  by  receiving  them  through  their  ears,  more 


286  ON  THE  DISEASES 

easily  acquire,  and  more  durably  retain,  them  in 
their  memories.  The  ear  is  less  apt  to  be  dis- 
tracted than  the  eye  by  the  obtrusion  of  surround- 
ing objects,  the  one  being  more  constant  than  the 
other.  The  mind  moreover  is  more  concentrated 
in  hearing  than  in  seeing.  The  truth  of  all  these 
remarks  is  confirmed,  by  few  of  the  sayings  or 
songs  learned  by  the  ear  only,  and  in  the  nursery, 
being  ever  forgotten. 

3.  The  memory  is  restored  and  strengthened 
by  means  of  association.     The  principal  circum- 
stances  which  influence  this  operation  of   the 
mind  are,  time,  place,  pleasure,  pain,  sounds, 
words,  letters,  habit,  and  interest. 

4.  Filling  the  mind  with  that  kind  of  know- 
ledge only,  which  is  supposed,  or  admitted,  to 
be  true.     The  errors  and  falsehoods  which  are 
crowded  into  the  memories  of  boys,  in  our  modern 
systems  of  education,  are  calculated  ever  after- 
wards to  weaken  their  retentive  powers  to  such 
subjects  as  are  true,  and  of  a  useful  and  practical 
nature. 

5.  The  memory  is  improved  by  using  it.  Its  low 
state  among  savages  is  occasioned  by  the  small 
number  of  objects  upon  which  they  exercise  it. 


OF  THE  MIND.  287 

6.  The  memory  is  aided  in  hearing,  and  after 
reading,  by  shutting  the  eyes.    In  this  way  Mr. 
Woodfall  received  and  retained  the  speeches  of 
the  members  of  the  British  parliament  until  he 
committed  them   to  paper,  after  which  he  pub- 
lished and  forgot  them. 

7.  Ideas,  and  even  words,  that  have  been  for- 
gotten, are  often  recalled  by  conversation  upon 
subjects  that  are  related  to  them.     This  is  effect- 
ed by  some  incidental  word,  or  idea,  awakening 
by  association  the  word  or  idea  we  wish  to  revive 
in  our  minds. 

8.  Dr.  Van  Rohr,  a  Danish  physician,  who 
visited  this  city  in  the  year  1793,  informed  me 
that  he  could  at  any  time  excite  the  remembrance 
of  words,  by  committing  two  or  three  lines  of 
poetry  to  memory. 

9.  Singing  aids  the  memory  in  acquiring  a 
knowledge  of  words,  and  of  the  ideas  connected 
with  them.     A  song  is  always  learned  sooner 
than  the  same  number  of  words  not  to  set  music. 

10.  Reading,  or  repeating  what  we  wish  to 
commit  to  memory,  the  last  thing  we  do  before 
we  go  to  bed. 


288  ON  THE  DISEASES 

11.  Learning  a  number  of  technical  or  arbi- 
trary terms,  and  associating  ideas  with  them. 
The  rules  for  making  syllogisms,  are  taught  in 
our  systems  of  logic  in  this  way.  Dr.  Gray's 
Memoria  Technica  may  be  read,  with  advantage, 
for  much  useful  knowledge  under  this  head. 


OF  THE  MIND.  289 


CHAPTER  XIII. 


Of  Fatuity. 

THIS  affection  of  the  mind  consists  in  a  total 
absence  of  understanding  and  memory.  It  has 
different  grades  from  the  lowest  degree  of  ma- 
nalgia,  down  to  that  which  discovers  itself  in 
a  vacuity  of  the  eye  and  countenance,  in  silence 
or  garrulity,  slobbering,  lolling  of  the  tongue,  and 
ludicrous  gestures  of  the  head  and  limbs. 

It  differs  further,  in  being  accompanied  with 
activity  in  the  will,  or  a  total  paralysis  of  it,  and 
with  active  passions,  or  the  total  absence  of  them. 
The  passions  which  most  commonly  appear  in 
idiots  are,  anger,  fear,  and  love.  They  moreover 
sometimes  feel  an  inordinate  degree  of  the  sexual 
appetite,  and  are  generally  great  feeders.  Lastly, 
they  are  innocent,  or  extremely  vicious. 

37 


290  ON  THE  DISEASES 

Fatuity,  or  idiotism,  is, 

1.  Congenial.  In  these  cases  the  skull  is  less, 
and  inferior  in  height  to  the  skulls  of  maniacs,  and 
there  is  a  great  disproportion  between  the  face 
and  head,  the  former  being  much  larger  than  the 
latter.  The  bones  of  the  head  are  preterna- 
turally  thick.  This  is  the  case  we  are  told  with' 
the  Cretins.  Dr.  Fodere,  who  has  written  an  in- 
teresting account  of  them,  says  they  have  no 
knowledge  of  their  parents,  nor  are  they  able  to 
feed  themselves  until  they  are  eight  or  ten  years 
of  age.  All  their  senses  are  torpid.  The  vene- 
real appetite  exists  in  them  with  great  force,  and 
they  gratify  it  after  puberty  by  the  practice  of 
onanism.  They  are  generally  inoffensive,  but 
now  and  then  very  mischievous.  There  is  a  case 
of  congenial  idiotism  in  a  boy  at  Kensington,  in 
the  neighbourhood  of  this  city,  in  which  the 
powers  of  the  body  and  mind  are  in  a  still  lower 
state  than  in  the  Cretins.  He  was  born  on  the 
5th  of  August,  1792,  and  is  at  this  time  unable  to 
walk  or  speak.  He  has  the  head  of  a  man, 
but  all  the  parts  of  his  body  below  it  resemble 
those  of  a  child  of  two  or  three  years  old,  particu- 
larly his  genitals  and  his  pulse ;  the  latter  beats 
from  90  to  120  strokes  in  a  minute.  He  has  shed 
his  teeth  twice,  and  now  exhibits  a  third  set,  in 


OP  THE  MIND.  291 

three  distinct  rows  in  his  upper  jaw.  With  all 
this  furniture  for  mastication,  he  is  unable  to 
chew  his  food,  and  all  that  he  takes  of  a  solid 
nature  is  first  chewed  for  him  by  his  sister.  His 
ears  are  very  large.  He  cries  when  hungry  and 
in  pain,  but  oftener  laughs  for  hours,  and  some- 
times for  whole  nights  together,  and  so  loud  as 
to  disturb  the  sleep  of  his  family.  He  discovers 
mind  in  but  three  things,  viz :  in  an  affection  for 
his  mother  and  sister,  and  in  a  love  for  a  dog,  and 
for  money.  His  father  sometimes  comes  home 
from  his  work  in  a  state  of  intoxication,  at  which 
time  he  abuses  his  mother  and  sister.  During  this 
time  he  appears  pensive,  and  refuses  to  eat  any 
thing.  He  discovers  distress  when  his  dog  is  out 
of  his  sight,  or  his  place  in  the  family  occupied 
by  the  dog  of  any  of  the  neighbours.  Of  his  love 
of  money  the  following  is  a  striking  proof.  I 
threw  a  piece  of  silver  into  his  lap.  He  instantly 
laughed  and  showed  other  signs  of  pleasure.  I 
found  upon  inquiry  that  he  was  fond  of  ginger- 
bread, and  that  he  had  just  memory  enough  to 
associate  the  pleasure  of  eating  it  with  the  sight 
of  the  means  of  procuring  it. 

Fatuity  is  induced  by  all  the  causes  which  bring 
on  mania,  particularly  by  chronic  fevers.  It  some- 


292  ON  THE  DISEASES 

times  succeeds  protracted  manalgia.  In  com- 
plete fatuity,  every  part  of  the  brain  is  torpid  or 
paralytic,  but  where  it  exists  with  any  of  the  pas- 
sions we  have  mentioned,  it  is  accompanied  with 
partial  diseased  action  in  the  brain. 

3.  Fatuity  is  induced  by  old  age,  in  conse- 
quence of  the  brain  becoming  so  torpid  and  in- 
sensible, as  to  be  unable  to  transmit,  impressions 
made  upon  it  to  the  mind.  It  is  partial,  or  gene- 
ral, according  to  the  greater  or  less  extent  of  the 
palsy  of  the  brain. 

Fatuity,  whether  a  partial  disease,  or  a  disor- 
der, has  been  cured, 

1.  By  another  disease.  The  author  has  men- 
tioned, in  his  Introductory  Lecture  upon  the 
Study  of  Medical  Jurisprudence,  a  curious  in- 
stance of  a  young  woman,  who  was  an  idiot  from 
her  childhood,  and  continued  so  until  her  35th 
year,  at  which  time  she  was  affected  with  pulmo- 
nary consumption.  The  impetus  of  the  blood  in 
the  hectic  fever  of  this  disease,  acting  upon  her 
brain,  awakened  her  long  dormant  mind,  and  pro- 
duced in  her  such  marks  of  reason,  that  she  asto- 
nished all  her  attendants  by  her  conversation. 


OP  THE  MIND.  293 

2.  It  has  been  cured  by  accidents,  such   as 
burns  and  falls,  and  particularly  when  they  affect 
the  head.     Dr.  Haller  relates  a  case  of  this  kind. 
Dr.  Nicholas   Robinson    mentions    another,    in 
which   the  cure  was   effected  by  a  fall  from  a 
horse.     After  the  disease  induced  by  this   fall 
ceased,  the  fatuity  returned. 

3.  Time  has  sometimes  cured  fatuity.     This 
has  frequently  been  observed  in  that  form  of  it 
which  succeeds  a  chronic  fever. 

4.  From  the  accidental  effects  of  the  remedies 
that  have  been  enumerated,  it  is  reasonable  to 
expect,  that  powerful  stimulants,  which  act  alike 
upon  the  whole  body  and  the  brain,  might  be  use- 
ful in  fatuity.     These   remedies  should   be  the 
same  that  were  recommended  formerly  for  the 
cure  of  manalgia.     That  form  of  fatuity,  which 
sometimes  follows  a  fever,  generally  yields  to  the 
most  lenient  of  these  remedies. 

In  order  to  assist  all  the  remedies  that  have 
been  mentioned,  it  will  be  useful,  as  soon  as  our 
patients  begin  to  discover  any  marks  of  the  re- 
vival of  mind,  to  oblige  them  to  apply  their  eye  to 
some  simple  and  entertaining  book.  They  will 
much  sooner  acquire  ideas  in  this  way,  than  by 


294 


ON  THE  DISEASES 


our  conversing  with  them,  in  consequence  of  the 
longer  impressions  of  words  upon  the  eyes  than 
upon  the  ears,  when  they  are  pronounced  in  the 
ordinary  rapid  manner  of  common  conversation. 
Dull  boys  are  sometimes  by  this  means  made 
scholars,  and,  on  the  contrary,  boys  of  active 
minds  are  sometimes  made  dull  by  it.  The  forci- 
ble impressions  of  words  in  the  latter  case  over- 
stimulates  the  mind.  Such  boys  learn  more  easily 
and  rapidly  by  oral  instruction. 

Fatuity  from  old  age  can  not  be  cured,  but  it 
may  be  prevented,  by  employing  the  mind  con- 
stantly in  reading  and  conversation,  in  the  even- 
ing of  life.     Dr.  Johnson  ascribes  the  fatuity  of 
Dean  Swift  to  two  causes;  1,  to  a  resolution  he 
made  in   his  youth,  that  he  would  never  wear 
spectacles,  from  the  want  of  which  he  was  unable 
to  read  in  the  decline  of  life ;  and,  2,  to  his  ava- 
rice, which  led  him  to  abscond  from  visiters,  or 
deny  himself  to  company,  by  which  means  he  de- 
prived himself  of  the  only  two  methods  by  which 
new  ideas  are  acquired,  or  old  ones  renovated. 
His  mind  from  these  causes  languished  from  the 
want  of  exercise,  and  gradually  collapsed  into 
idiotism,  in  which  state  he  spent  the  close  of  his 
life  in  a  hospital,  founded  by  himself  for  persons 
afflicted  with   the  same  disorder,  of  which   he 
finally  died. 


OF    THE   MIND.  295 

Country  people,  who  have  no  relish  for  books, 
when  they  lose  the  ability  to  work,  or  of  going 
abroad,  from  age,  or  weakness,  are  very  apt  to 
become  fatuitous,  especially  as  they  are  too  often 
deserted  in  their  old  age  by  the  younger  branches 
of  their  families,  in  consequence  of  which  their 
minds  become  torpid,  from  the  want  society 
and  conversation.  Fatuity  is  more  rare  in  cities 
than  in  country  places,  only  because  society  and 
conversation  can  be  had  in  them  upon  more  easy 
terms ;  and  it  is  less  common  among  women  than 
men,  only  because  they  seldom  survive  their 
ability  to  work,  and  because  their  employments 
are  of  such  a  nature,  as  to  admit  of  their  being 
carried  on  by  their  fire-sides,  and  in  a  sedentary 
posture. 

The  illustrious  Dr.  Franklin  exhibited  a  strik- 
ing instance  of  the  influence  of  reading,  writing, 
and  conversation,  in  prolonging  a  sound  and 
active  state  of  alhhe  faculties  of  his  mind.  In  his 
eighty-fourth  year  he  discovered  no  one  mark,  in 
any  of  them,  of  the  weakness  or  decay  usually 
observed  in  the  minds  of  persons  at  that  advanced 
period  of  life. 

I  can  not  dismiss  this  subject  without  remark- 
ing that  the  moral  faculties,  when  properly  regu- 


296  ON  THE  DISEASES 

lated  and  directed,  never  partake  of  the  decay  of 
the  intellectual  faculties  in  old  age,  even  in  per- 
sons of  uncultivated  minds.  It  would  seem  as  if 
they  were  thus  placed  beyond  the  influence,  not 
only  of  time,  but  often  of  diseases  and  accidents 
from  their  exercises  being  so  indispensably  ne- 
cessary to  our  happiness,  more  especially  in  the 
evening  of  life. 

The  Rev.  Dr.  Magaw,  I  said  formerly,  had  lost, 
with  his  memory  for  events,  his  consciousness 
of  place  and  time,  by  a  paralytic  disease,  and 
yet  in  this  situation  he  retained,  for  several  years, 
so  high  a  sense  of  religious  obligation,  that  he 
performed  his  devotions  morning  and  evening, 
and  at  his  meals,  with  as  much  regularity  and 
correctness,  as  ever  he  did  in  the  most  vigorous 
and  healthy  state  of  his  mind. 

There  is  a  state  of  fatuity,  related  to  that  which 
has  been  described,  in  which  there  exists,  with 
great  feebleness  of  mind,  a  species  of  low  wit  and 
cunning,  accompanied  at  times  with  mimickry. 
Shakspeare  has  described  this  grade  of  idiotism 
in  his  character  of  the  fool,  in  the  tragedy  of  King 
Lear.  Such  persons  were  formerly  in  demand 
at  courts,  as  jesters,  in  order  to  dissipate,  by  their 


OF  THE  MIND.  297 

buffoonery,  the  ennui  which  is  created  by  a  super- 
fluity of  the  enjoyments  of  life. 

It  is  possible  this  mental  disease  might  be  re- 
lieved by  the  same  remedies  that  have  been 
recommended  for  common  fatuity. 


38 


298  ON  THE  DISEASES 


CHAPTER  XIV. 


Of  Dreaming,  Incubus,  or  Night  Mare,  and 
Somnambulism. 


To  enumerate  all  the  phenomena  of  dreams, 
and  to  attempt  an  explanation  of  their  proximate 
cause,  would  require  a  previous  account  of  the 
theory  of  sleep,  and  this  would  render  it  necessary 
to  introduce  several  physiological  principles,  all 
of  which  would  be  foreign  to  the  practical  ob- 
jects of  this  work ;  for  which  reason  I  shall  barely 
remark,  that  dreaming  is  the  effect  of  unsound  or 
imperfect  sleep.  That  this  is  the  case  is  obvious, 
from  its  being  uncommon  among  persons  who 
labour,  and  sleep  soundly  afterwards,  and  from 
its  causes  to  be  mentioned  presently.  It  is 
always  influenced  by  morbid  or  irregular  action 
in  the  blood-vessels  of  the  brain,  and  hence  it  is 
accompanied  with  the  same  erroneous  train,  or 
the  same  incoherence  of  thought,  which  takes  place 
in  delirium.  This  is  so  much  the  case,  that  a 
dream  may  be  considered  as  a  transient  parox- 
ysm of  delirium,  and  delirium  as  a  permanent 


OP  THE  MIND.  299 

dream.    It  differs  from  madness  in  not  being  at- 
tended with  muscular  action. 

As  dreams  are  generally  accompanied  with  dis- 
tress, and  are  often  the  premonitory  signs  of  acute 
diseases,  their  cure  is  an  important  object  of  the 
science  of  medicine.  Their  remote  causes  are  an 
increase,  or  diminution,  of  stimuli  upon  the  brain. 

I.  The  increased  stimuli  are  corporeal,  and 
mental. 

1.  The  corporeal  stimuli    are,  an    excessive 
quantity  of  aliments  or  drinks,  or  of  both,  of  an 
offensive  quality  to  the  stomach,  a  position  of  the 
head  not  habitual  to  the  patient,  cold,  heat,  noises, 
a  tight  collar  or  wrist-bands,  a  fever,  opium,  a  full 
bladder,  inclination  to  go  to  stool,  and,  lastly, 
light.    It  is  from  the  stimulus  of  the  last  cause 
that   we    dream  most   after    daybreak    in    the 
morning. 

2.  The  mental  stimuli  are,  all  disquieting  pas- 
sions, difficult  studies  begun  at  bed  time,  and  an 
undue  weight  of  business. 

II.  Dreams  are  induced  by  the  diminution  of 
habitual  stimuli,  such  as  customary  food,  drinks, 


300  ON  THE  DISEASES 

exercise,  labour,  studies,  and  business.  They  are 
sometimes  terrifying,  or  distressing,  and  not  only 
detract  from  the  happiness  of  life,  but,  when  ne- 
glected, become  the  cause  of  more  serious  dis- 
eases in  the  brain.  The  remedies  for  them,  when 
they  are  induced  by  an  increase  of  stimuli,  whe- 
ther corporeal  or  mental,  should  be, 

1.  Bleeding,  or  gentle  purges,  and  low  diet. 
The  famous  pedestrian  traveller,  Mr.  Stewart,  in- 
formed me  that  he  never  dreamed  when  he  lived 
exclusively  upon  vegetable  food. 

2.  Exercise,  or  labour,  which  reduces  excite- 
ment, and  wastes  excitability  down  to  the  point 
of  natural  and  sound  sleep.     Persons  who  work 
hard  during  the  day  seldom  dream. 

3.  Avoiding  all  its  remote  and  exciting  causes 
more  especially  such  of  them  as  act  upon  the 
mind  in  the  evening. 

4.  When  dreaming  arises  from  a  diminution  of 
customary  stimuli,  a  light  supper,  a  draught  of 
porter,  a  glass  of  wine,  or  a  dose  of  opium,  gene- 
rally prevent  them.     Habitual  noises,  when  sus- 
pended, should  be  restored. 


OP  THE  MIND.  301 


Of  the  Incubus,  or  Night  Mare. 

This  disease  is  induced  by  a  stagnation  of  the 
blood  in  the  brain,  lungs,  or  heart.  It  occurs 
when  sleep  is  more  profound  than  natural.  Its 
remote  causes  are  the  same  as  of  dreams.  To 
these  may  be  added  sleeping  upon  the  back,  by 
which  means  the  blood  is  disposed  to  stagnate  in 
the  places  above-mentioned,  from  an  excess  or 
diminution  of  the  force  that  moves  it.  Persons 
who  go  to  bed  in  good  health,  and  are  found 
dead  in  their  beds  in  the  morning,  it  is  supposed, 
generally  die  of  this  disease. 

Its  remedies  should  be  the  same  as  for  dreams, 
with  the  additional  one  of  sleeping  alternately  on 
each  side. 

Of  Somnambulism. 

I  shall  introduce  my  remarks  upon  this  disease 
by  copying  Dr.  Hartly's  correct  and  perspicuous 
account  of  its  cause,  in  his  "  Observations  upon 
Man." 


302  ON  THE  DISEASES 

"  Those  who  walk  and  talk  in  their  sleep  (says 
the  doctor)  have  evidently  the  nerves  of  the  mus- 
cles concerned  so  free,  as  that  vibrations  [or  ner- 
vous influence]  can  descend  from  the  internal 
parts  of  the  brain,  the  peculiar  residence  of  ideas, 
into  them.  At  the  same  time,  the  brain  itself  is 
so  oppressed,  that  they  have  scarce  any  memory. 
Persons  who  read  inattentively,  that  is,  see  and 
speak  almost  without  remembering:  also  those 
who  labour  under  such  a  morbid  loss  of  memory, 
as  that  though  they  see,  hear,  speak  and  act,  pro 
ne  wa/a,  from  moment  to  moment,  yet  forget  all 
immediately,  somewhat  resemble  the  persons 
who  walk  and  talk  in  their  sleep." 

Dreaming,  I  have  said,  is  a  transient  paroxysm 
of  delirium.  Somnambulism  is  nothing  but  a 
higher  grade  of  the  same  disease.  It  is  a  tran- 
sient paroxysm  of  madness.  Like  madness  it  is 
accompanied  with  muscular  action,  with  inco- 
herent, or  coherent  conduct,  and  with  that  com- 
plete oblivion  of  both,  which  takes  place  in  the 
worst  grade  of  madness.  Coherence  of  conduct 
discovers  itself,  in  persons  who  are  affected  with 
it  undertaking,  or  resuming,  certain  habitual  ex- 
ercises or  employments.  Thus  we  read  of  the 
scholar  resuming  his  studies,  the  poet  his  pen, 
and  the  artisan  his  labours,  while  under  its  influ- 


OP  THE  MIND.  303 

ence,  with  their  usual  industry,  taste  and  correct- 
ness. It  extended  still  further  in  the  late  Dr. 
Blacklock,  of  Edinburgh,  who  rose  from  his  bed, 
to  which  he  had  retired  at  an  early  hour,  came 
into  the  room  where  his  family  was  assembled, 
conversed  with  them,  and  afterwards  entertained 
them  with  a  pleasant  song,  without  any  of  them 
suspecting  he  was  asleep,  and  without  his  retain- 
ing, after  he  awoke,  the  least  recollection  of  what 
he  had  done. 

Persons  who  are  affected  with  this  disease, 
sometimes  appear  pale,  and  covered  with  profuse 
sweats. 

Its  REMEDIES  should  be  the  same  as  for  dream- 
ing, when  it  arises  from  an  increase  of  corporeal 
or  mental  stimuli.  I  have  read  an  account  of 
two  cures  being  performed,  by  placing  a  tub  of 
water  in  the  bedroom  of  the  persons  who  were 
afflicted  with  it. 


304  ON  THE  DISEASES 


CHAPTER  XV. 


Of  Illusions. 

BY  this  term  I  mean  that  disease,  in  which 
false  perceptions  take  place  in  the  ears  and  eyes 
in  the  waking  state,  from  a  morbid  affection  of 
the  brain  or  of  the  s-ense  which  is  the  seat  of  the 
illusion.  It  may  be  considered  as  a  waking 
dream.  Persons  affected  with  it,  fancy  they  hear 
voices,  or  see  objects  that  do  not  exist.  These 
false  perceptions  are  said,  by  superstitious  peo- 
ple, to  be  premonitions  of  death.  They  sometimes 
indicate  either  the  forming  state  or  the  actual 
existence  of  disease,  which  being  seated  most 
commonly  in  a  highly  vital  part  of  the  body,  that 
is,  the  brain,  now  and  then  ends  in  death,  and 
thus  administers  support  to  superstition.  They 
depend,  like  false  perception  in  madness,  upon 
motion  being  excited  in  a  part  of  the  ear  or  the 
eye,  which  does  not  vibrate  with  the  impression 


OF  THE  MIND.  305 

made  upon  it,  but  communicates  it  to  a  part  upon 
which  the  impression  of  the  noise  heard,  or  of  the 
person  seen,  was  formerly  made,  and  hence  the 
one  becomes  audible,  and  the  other  visible. 

The  deception,  when  made  upon  the  ears,  con- 
sists most  commonly  in  hearing  our  own  names, 
and  for  this  obvious  reason ;  we  are  accustomed 
to  hear  them  pronounced  more  frequently  than 
any  other  words,  and  hence  the  part  of  the  ear, 
which  vibrates  with  the  sound  of  our  names, 
moves  more  promptly,  from  habit,  than  any  other 
part  of  it.  For  the  same  reason  the  deception, 
when  made  upon  the  eyes,  consists  in  seeing  our 
own  persons,  or  the  persons  of  our  intimate 
friends,  whether  living  or  dead,  oftener  than  any 
other  people.  The  part  upon  the  retina,  from 
which  those  images  are  reflected,  moves  more 
promptly,  from  habit,  than  any  other  of  that  part 
of  the  organ  of  vision. 

The  voice  which  is  supposed  to  be  heard,  and 
the  objects  which  are  supposed  to  be  seen,  are 
never  heard  nor  seen  by  two  persons,  even  when 
they  are  close  to  each  other.  This  proves  them 
both  to  be  the  effect  of  disease  in  the  single  per- 
son who  hears,  or  sees,  the  supposed  voice  or  ob- 
ject. I  am  aware  that  this  explanation  of  illu- 

39 


306  ON  THE  DISEASES 

sions  may  be  applied  to  invalidate  the  accounts 
that  are  given  in  the  Old  and  New  Testaments 
of  the  supernatural  voices  and  objects,  that  were 
heard  or  seen  by  individuals,  particularly  by 
Daniel,  Elisha,  and  St.  Paul ;  but  they  should  no 
more  have  that  effect,  than  the  cures  of  diseases 
that  are  performed  by  natural  means  should  in- 
validate the  accounts  that  are  given  in  those 
books,  of  the  same  diseases  being  cured  in  a  mi- 
raculous manner.  But,  admitting  the  voices  or 
objects  that  were  heard  or  seen,  by  the  prophets 
and  apostle  above-mentioned,  to  have  been  pro- 
duced by  a  change  in  the  natural  actions  of  the 
brain,  or  of  the  organs  of  hearing  or  seeing  that 
change,  considering  its  design,  was  no  less  super- 
natural, than  if  the  voices  or  objects  supposed  to 
have  been  heard,  or  seen,  had  been  real.  It  is 
remarkable,  that  in  all  those  cases,  where  mira- 
cles were  necessary  to  establish  a  divine  com- 
mission, or  a  new  doctrine,  every  circumstance 
connected  with  them  was  distinctly  heard,  or 
seen,  not  by  an  individual  only,  but  by  two  or 
three,  and  sometimes  by  several  hundred  wit- 
nesses, in  all  of  whom  it  is  scarcely  possible  for 
an  illusion  to  have  existed  at  the  same  time  from 
natural  causes. 

The  remedies  for  illusions  should  be,  bleeding, 


OP  THE  MIND.  307 

purges,  and  low  diet,  when  the  pulse  indicates 
undue  excitement  in  the  arterial  system.  A  cer- 
tain Mr.  Nicholai,  a  member  of  the  Academy  of 
Sciences  in  Berlin,  was  much  relieved  of  this 
disease  by  the  application  of  leeches  to  the 
haemorrhoidal  vessels. 

In  a  reduced  state  of  the  system,  the  remedies 
should  be  cordial  diet  and  tonic  medicines.  Mr. 
Nicholai  heard  the  voices  of  his  friends  only 
when  he  was  alone,  and  in  a  state  of  inaction. 
This  fact  suggests  the  advantages  of  company 
and  exercise,  as  additional  remedies  in  this  dis- 
ease. 


308  ON  THE  DISEASES 


CHAPTER  XVI. 

Of  Revery,  or  Absence  of  Mind. 
THIS  disease  is  induced  by  two  causes, 

1.  By  the  stimulus  of  ideas  of  absent  subjects 
being  so  powerful,  as  to  destroy  the  perception 
of  .present  objects ;  and, 

2.  By  a  torpor  of  mind  so  great  as  not  to  feel 
the  impressions  of  surrounding  objects  upon  the 
sense.     It  is  an  inferior  or  feeble  grade  of  ca- 
talepsy. 

It  is  more  common  from  the  latter  than  the 
former  cause.  It  is  no  objection  to  this  asser- 
tion, that  it  sometimes  occurs  in  scholars,  and  in 
men  celebrated  for  their  great  literary  attain- 
ments. A  capacity  for  acquiring  knowledge  is  a 
cheap  endowment,  and  differs  widely  from  that 
capacity,  which  enables  a  man  not  only  to  ac- 
quire knowledge  from  books,  but  to  create  it  by 
observation  and  reflection,  and  to  apply  it  to  the 


OP  THE  MIND.  309 

useful  purposes  of  life.  The  following  account  of 
a  clergyman,  who  died  a  few  years  ago  in  En- 
gland, extracted  from  a  late  periodical  work,  will 
serve  to  exhibit  the  nature  and  extent  of  this  in- 
tellectual disease,  from  the  latter  cause  that  was 
mentioned. 

"Mr.  George  Harvest,  minister  of  Thames 
Ditton,  was  one  of  the  most  absent  men  of  his 
time ;  he  was  a  lover  of  good  eating,  almost  to 
gluttony;  and  was  further  remarkable  as  a  great 
fisherman;  very  negligent  in  his  dress,  and  a  be- 
liever in  ghosts.  In  his  youth  he  was  contracted 
to  a  daughter  of  the  bishop  of  London ;  but  on 
his  wedding  day,  being  gudgeon  fishing,  he  over- 
staid  the  canonical  hour;  and  the  lady,  justly 
offended  at  his  neglect,  broke  off  the  match.  He 
had,  at  that  time,  an  estate  of  300/.  per  annum, 
but,  from  inattention  and  absence,  suffered  his 
servants  to  run  him  in  debt  so  much,  that  it  was 
soon  spent.  It  is  said,  that  his  maid  frequently 
gave  balls  to  her  friends  and  fellow  servants  of 
the  neighbourhood,  and  persuaded  her  master 
that  the  noise  he  heard  was  the  effect  of  wind. 

"  In  the  latter  part  of  his  life  no  one  would 
lend,  or  let  him  a  horse,  as  he  frequently  lost  his 
beast  from  under  him,  or  at  least  out  of  his  hand^, 


310  ON  THE  DISEASES 

it  being  his  practice  to  dismount  and  lead  his 
horse,  putting  the  bridle  under  his  arm,  which 
the  horse  sometimes  shook  off,  and  sometimes  it 
was  taken  off  by  the  boys,  and  the  parson  seen 
drawing  his  bridle  after  him. 

"  Sometimes  he  would  purchase  a  penny-worth 
of  shrimps,  and  put  them  in  his  waistcoat  pocket, 
among  tobacco,  worms,  gentles  for  fishing,  and 
other  trumpery :  these  he  often  carried  about  him 
till  they  stunk,  so  as  to  make  his  presence  almost 
insufferable.  I  once  saw  such  a  melange  turned 
out  of  his  pocket  by  the  dowager  lady  Pembroke. 
With  all  these  peculiarities,  he  was  a  man  of 
some  classical  learning,  and  a  deep  metaphysi- 
cian, though  generally  reckoned  a  little  cracked. 

"  Such  was  his  absence  and  distraction,  that  he 
frequently  used  to  forget  the  prayer  days,  and  to 
walk  to  his  church  with  his  gun,  to  see  what 
could  have  assembled  the  people  there. 

"  In  company  he  never  put  the  bottle  round, 
but  always  filled  when  it  stood  opposite  to  him  ; 
so  that  he  very  often  took  half  a  dozen  glasses 
running.  That  he  alone  was  drunk,  and  the  rest 
of  the  company  sober,  is  not,  therefore,  to  be 
wondered  at. 


OP  THE  MIND.  311 

"  One  day  Mr.  Harvest,  being  in  a  punt  on  the 
river  Thames  with  Mr.  Ostow,  began  to  read  a 
beautiful  passage  in  some  Greek  author,  and 
throwing  himself  backwards  in  an  ecstacy,  fell 
into  the  water,  whence  he  was  with  difficulty 
fished  out. 

"  Once,  being  to  preach  before  the  clergy  at 
the  visitation,  he  had  three  sermons  in  his  pocket: 
some  wags  got  possession  of  them,  mixed  the 
leaves  and  sewed  them  all  up  as  one:  Mr.  Har- 
vest began  his  sermon,  and  soon  lost  the  thread 
of  his  discourse,  and  got  confused :  but  neverthe- 
less continued,  till  he  had  preached  out  first  all 
the  church-wardens,  and  next  the  clergy,  who 
thought  he  was  taken  mad." 

It  is  possible  moderate  depletion,  succeeded 
by  constant  and  noisy  company  might  produce  in 
the  mind  a  predominance  of  impressions  from 
present  objects,  over  those  of  the  ideas  of  absent 
subjects.  Stimulants,  particularly  such  as  act 
upon  the  brain  and  nervous  system,  would  pro- 
bably be  useful,  when  the  disorder  arises  from 
torpor  of  mind,  or  insensibility  of  the  senses. 


312  ON  THE  DISEASES 


CHAPTER  XVII. 

On  Derangement  of  the  Passions. 

THE  passions  have  been  divided  into  two  great 
classes,  1,  such  as  are  intended  to  impel  us  to 
real  or  supposed  good ;  and,  2,  such  as  are  in- 
tended to  defend  us  from  real,  or  supposed  evil. 
The  former  are  objects  of  desire,  the  latter  of 
aversion.  Those  of  them  which  are  most  sub- 
ject to  derangement,  or  to  an  unreasonable  and 
morbid  excess,  are  love,  grief,  fear,  and  anger. 
After  mentioning  the  symptoms  of  their  diseases, 
and  their  remedies,  I  shall  consider  that  morbid 
phenomena  of  joy,  envy,  malice,  and  hatred,  and 
conclude  the  chapter  with  a  few  remarks  upon 
the  torpor  of  the  passions. 

Of  Love. 

This  passion,  which  was  implanted  in  the  hu- 
man breast  for  the  purpose  of  bringing  the  sexes 
together,  and  thereby  increasing  their  happiness, 
becomes  a  disease  only  where  it  is  disappointed  in 


OP  THE  MIND.  313 

its  object.  The  symptoms  of  love,  when  it  creates 
disease,  are  sighing,  wakefulness,  perpetual  talk- 
ing, or  silence,  upon  the  subject  of  the  object  be- 
loved, and   a    predilection  to  solitude.     Where 
these  symptoms  do  not  discover  its  existence,  it 
may  be  known  in  a  man,   by  blushing,  and  an 
increased  frequency  of  pulse,  when  the  name  of 
the  person  beloved  is  mentioned;  and  in  a  wo- 
man,  according  to  La  Bruyere,  "by  her  con- 
stantly looking  at  the  man  she  loves,  when  in 
company,  or  never  looking  at  him  at  all."    It  is 
known  further  in  a  woman,  by  her  retiring  to  de- 
corate herself  upon  the  appearance  of  the  man  in 
company  whom  she  loves.     It  always  renders  a 
woman  awkward,  but  it  polishes  the  manners  of 
men.     The  effects  of  unsuccessful  love  are  dys- 
pepsia, hysteria,  hypochondriasis,  fever,  and  mad- 
ness.    The  last  has  sometimes  induced  suicide, 
while  all  the  others  have  now  and  then  ended  in 
death. 

The  remedies  for  this  disease,  when  accompa- 
nied with  fever  or  great  excitement,  in  the  brain, 
or  any  other  part  of  the  system,  should  be, 

1.  Bleeding,  blistering,  and  the  other  remedies 
for  similar  states  of  the  system  from  other  causes. 
It  is  remarkable,  that  persons  who  have  been 

40 


314  ON  THE  DISEASES 

cured  of  the  diseases  from  love,  by  these  reme- 
dies, recover  without  feeling  any  affection  for  the 
persons  they  have  loved.  This  was  the  case  with 
one  of  the  princes  of  Conde.  He  complained,  in 
this  state  of  mind,  that  his  physicians  had  drawn 
off  all  his  love  for  his  mistress  by  their  depleting 
remedies. 

2.  Ovid  advises  what  he  calls  a  "  binam  ami- 
cam,"  that  is,  a  new  mistress,  for  unsuccessful 
love.    I  have  known  this  remedy  to  succeed  in 
several  instances.     The   sincerity  of   a  former 
attachment  is  often  called  in  question,  by  a  sud- 
den translation  of  the  affections  to  a  second  mis- 
tress, but  without   any    foundation.     Indeed,  it 
proves  its  sincerity,  for  its  ardour  admits  of  no 
other  cure. 

3.  The  same  master  of  the  subject  of  love, 
Ovid,  advises  an  unsuccessful  lover  to  find  out, 
and  dwell  upon  all  the  bad  qualities,  and  defects, 
in  person  and  accomplishments,  of  his  mistress. 
"  If  she  have  a  bad  voice  (says  he)  press  her  to 
sing ;  if  she  touch  a  musical  instrument  clumsily, 
beg  her  to  expose  herself  by  playing  upon  one  of 
them." 

4.  The  company  of  the  person  beloved  should 
be  carefully  avoided.  A  voyage  or  journey  should 


OP  THE  MIND.  3  1 5 

be  advised  in  this  case,  for  absence  has  been 
justly  styled  the  tomb  of  love.  The  company  of 
strangers,  by  checking  all  conversation  about  the 
person  beloved,  prevents  the  passion  being  che- 
rished by  it. 

5.  Constant  employment  will  aid  absence  as  a 
remedy  for  hopeless  love.     The  more  that  em- 
ployment interests  the  understanding,  the  more 
completely  it  will  have  that  effect.     The  disease 
is  more  than  half  cured  when  the  distressed  lover 
ceases  to  think  of  the  object  of  his  affections. 

6.  As  hope  and  love  are  born  together,  so  they 
can  only  die  together.     Uncommon  pains  there- 
fore should  be  taken,  in  curing  love,  to  extinguish 
every  spark  of  hope  in  a  lover.     This  advice  is 
given  with  singular  good  sense  and  humanity  by 
Dr.  Gregory,  in  his   Legacy  to  his  Daughters, 
upon  the  subject  of  courtship  and  marriage. 

7.  Unsuccessful  love  is  cured  by  exciting  a 
more  powerful  passion  in  the  mind.     Ambition 
should  be  preferred  for  this  purpose.     Its  efficacy 
is  taken  notice  of  by  the  duke  of  Rochefaucalt. 
"  Ambition  (he  says)  may  succeed  love,  but  love 
never  cures  ambition." 


316  ON  THE  DISEASES 


Of  Grief. 

Physicians,  in  their  unsuccessful  efforts  to  save 
life,  are  often  obliged  to  witness  this  passion.  It 
is  of  consequence  for  them,  therefore,  to  be  well 
acquainted  with  its  symptoms  and  cure. 

Its  symptoms  are  acute  and  chronic.  The  for- 
mer are,  insensibility,  syncope,  asphyxia,  and  apo- 
plexy; the  latter  are,  fever,  wakefulness,  sighing, 
with  and  without  tears,  dyspepsia,  hypochondri- 
asis,  loss  of  memory,  gray  hairs,  marks  of  prema- 
ture old  age  in  the  countenance,  catalepsy,  and 
madness.  It  sometimes  brings  on  sudden  death, 
without  any  signs  of  previous  disease,  either  acute 
or  chronic.  Dissections  of  persons  who  have  died 
of  grief,  show  congestion  in,  and  inflammation  of, 
the  heart,  with  a  rupture  of  its  auricles  and  ven- 
tricles. But  there  are  instances,  in  which  the 
sympathy  of  the  heart  with  the  whole  system  is  so 
completely  dissevered  by  grief,  that  the  subject  of 
it  discovers  not  one  mark  of  it  in  his  countenance 
or  behaviour.  On  the  contrary,  he  sometimes 
exhibits  signs  of  unbecoming  levity  in  his  inter- 
course with  the  world.  This  state  of  mind  soon 
passes  away,  and  is  generally  followed  by  all  the 


OP  THE  MIND.  317 

obvious  and  natural  signs  of  the  most  poignant 
and  durable  grief. 

There  is  another  symptom  of  grief,  which  is 
not  often  noticed,  and  that  is  profound  sleep.  I 
have  often  witnessed  it  even  in  mothers,  imme- 
diately after  the  death  of  a  child.  Criminals,  we 
are  told  by  Mr.  Akerman,  the  keeper  of  Newgate 
in  London,  often  sleep  soundly  the  night  before 
their  execution.  The  son  of  General  Custine 
slept  nine  hours,  the  night  before  he  was  led  to 
the  guillotine  in  Paris.  These  facts,  and  many 
similar  ones  that  might  be  mentioned,  will  serve 
to  vindicate  the  disciples  of  our  Saviour  from  a 
want  of  sympathy  with  him  in  his  suffering.  They 
slept  during  his  agony  in  the  garden,  because 
their  "  flesh  was  weak,"  and  in  consequence  of 
"  sorrow  having  filled  their  hearts." 

The  remedies  for  grief  are  physical  and  moral. 
To  enumerate  the  latter  would  be  foreign  to  the 
design  of  these  inquiries.  They  belong  moreover 
to  another  profession.  I  shall  barely  glance  at 
them  without  separating  them  from  those  that 
are  of  a  physical  nature. 

The  first  remedy,  that  is  indicated  in  recent 
grief,  is  opium.  It  should  be  given  in  liberal 
doses  in  its  first  paroxysm,  and  it  should  be  re- 


318  ON  THE  DISEASES 

peated  afterwards,  in  order  to  obviate  wakeful- 


ness. 


2.  From  the  relief  which  the  discharge  of  tears 
affords  in  grief,  pains  should  be  taken  to  procure 
it.     The  means  for  this  purpose  are,  obtruding 
upon  the  mind  a  sorrow  of  a  less  grade  than  that 
by  which  it  is  depressed.     Ancient  history  fur- 
nishes us  with  a  pathetic  example  of  the  efficacy 
of  this  remedy.     Psamminitus,  one  of  the  kings 
of  Egypt,   with  his  son.  daughter  and  servant, 
were  taken  prisoners  by  Cambysis,  king  of  Persia. 
Soon  after  his  captivity,  he  beheld  his  daughter 
sent  in  the  habit  of  a  servant  to  draw  water. 
This  sight  drew  tears  from  his  attendants,  but 
produced  no  sign  of  distress  in  the  king  of  Egypt. 
Immediately  afterwards  his  son  was  conducted 
before  his  eyes  to  a  place  of  execution.     This 
sight  he  likewise  saw  without  an  emotion  of  any 
kind.     His   servant  next  appeared  before  him, 
among  a  number  of  other  captives.     This  sight, 
although  accompanied  with  less  distress  than  the 
two  former,  overcame  him,  and  he  suddenly  burst 
into  tears.     It  has  been  said,  that  "  sorrows  sel- 
dom come  alone."     The  goodness  of  heaven  is 
obvious  in  this  dispensation  of  the  evils  of  life ; 
for,  as  sorrows  generally  differ  in  their  degrees, 
such  of  them  as  are  great,  by  weakening  sensi- 


OF  THE  MIND.  319 

bility,  lessen  the  pain  from  the  pressure  of  suc- 
cessive lighter  ones,  while  such  as  are  originally 
light,  prepare  the  mind  for  the  pressure  of  such 
as  exceed  them. 

3.  Should  the  system  re-act,  and  symptoms  of 
great  excitement  appear  in  the  blood-vessels  or 
brain,  bleeding  and  purges  should  be  prescribed. 
The  latter  will  be  rendered  necessary,  by  the  ex- 
hibition of  opium. 

4.  The  persons  afflicted  with  grief,  should  be 
carried  from  the  room  in  which  their  relations 
have  died,  nor  should  they  ever  see  their  bodies 
afterwards.     They  should  by  no  means  be  per- 
mitted to  follow  them  to  the  grave.     It  would  be 
useful  to  inter  the  body  of  the  deceased  as  far  as 
possible  from  the  view  of  the  person,  who  is  the 
subject  of  grief.     Grave-yards  in  a  city,  and  in 
places  of  public  resort,  are  very  improper,  inas- 
much as  they  either  renew,  and  perpetuate  grief, 
or  create  insensibility  to  death,  and  a  criminal 
indifference  to  human  dust.    The  patriarch  Abra- 
ham understood  these  principles  in  the  human 
heart;  hence  we  read,  when  his  wife  died,  he  re- 
fused to  bury  her  in  the  sepulchres  of  the  sons  of 
Heth,  but  entreated  them  to  sell  him  a  piece  of 
ground,  that  he  might  «  bury  her  out  of  his  sight." 


320  ON  THE  DISEASES 

A  similar  practice  was  adopted  by  the  descen- 
dants of  this  patriarch,  who  inhabited  ancient 
Judea.  Their  grave-yards  were  always  placed 
2000  cubits  from  their  cities.  The  sepulchres  or 
vaults  of  the  wealthy  were  in  their  gardens,  which 
were  situated  in  the  neighbourhood  of  their  cities. 
These  facts  will  render  not  only  more  credible, 
but  more  intelligible,  the  account  given  in  the 
New  Testament  of  the  agony  of  our  Saviour 
being  in  a  garden,  near  the  city  of  Jerusalem,  and 
his  tomb,  a  sepulchre  in  which  no  man  had  laid. 

The  Chinese,  like  the  Jews,  inter  their  dead 
out  of  their  cities.  The  Russians  bury  their  dead 
after  night,  probably  to  prevent  unnecessary  grief. 

5.  As  soon  as  the  ceremonies  and  bustle  of 
the  funeral  are  over,  persons  afflicted  with  grief 
should  be  advised  to  receive  the  visits  of  their 
friends,  of  whom  the  physician  should  always  be 
one.  In  their  first  visit  to  persons  recently  be- 
reaved of  their  relations,  they  should  imitate  the 
conduct  of  Job's  friends,  who  after  weeping  for 
his  losses  and  afflictions  when  they  beheld  him 
afar  off,  the  sacred  historian  tells  us,  "  sat  down 
with  him  upon  the  ground,  seven  days,  and  seven 
nights,  and  none  spake  a  word  to  him,  for  the/ 
saw  his  grief  was  very  great."  Mr.  Sterne  has 


OF  THE  MIND.  321 

imitated,  but  not  equalled,  this  delicate  and  af- 
fecting passage,  in  his  history  of  his  uncle  Toby. 
In  his  first  visit  to  his  brother,  after  the  death  of 
his  son,  "  he  sat  down  (says  Sterne)  in  an  armed 
chair,  at  the  head  of  a  bed  in  which  his  brother 

lay, — and said  nothing."    There  is  science, 

as  well  as  sympathy  in  this  silence,  for  in  this 
way,  grief  most  rapidly  passes  from  the  bosom  of 
the  sufferer  into  that  of  his  friend. 

As  soon  as  it  is  proper  to  begin  a  conversation 
with  a  person  under  the  pressure  of  recent  grief, 
such  consolations  should  be  suggested,  as  are 
offered  by  reason  and  religion.  Dr.  Stonehouse, 
the  physician  and  friend  of  the  pious  Mr.  Harvey, 
made  it  a  practice  to  send  a  copy  of  a  little  work, 
entitled  "  The  Mourner,"  written  by  Dr.  Grove- 
nor,  to  the  friends  of  every  patient  he  lost.  It  is 
an  excellent  book,  and  well  calculated  to  com- 
pose the  mind  under  this  kind  of  affliction.  A 
physician  should  listen  to  the  history  of  the  last 
stage  of  his  patient's  disease,  and  to  the  details 
of  the  appearances  of  the  body  after  death.  Much 
knowledge  may  be  picked  up  in  this  way,  which 
would  otherwise  perish.  If  any  prejudice  or  mis- 
take has  taken  place  respecting  his  opinion  of 
the  nature  of  the  disease  of  which  his  patient  has 
died,  or  of  the  effects  of  any  of  his  remedies,  he 

41 


322  ON  THE  DISEASES 

may  remove  or  correct  them.  By  a  visit  thus 
paid,  and  employed,  a  physician  not  only  wards 
off  any  complaint  of  his  want  of  skill,  but  in- 
creases the  confidence  of  his  patients  in  it,  and 
often  secures  their  attachment  to  him  through 
his  subsequent  life. 

6.  After  the  expiration  of -the  weeks  of  mourn- 
ing, care  should  be  taken  never  to  mention  the 
names  of  the  deceased  persons  to  any  of  their 
friends,  nor  to  allude  to  any  thing  that  by  means 
of  association  can  revive  their  memories.  The 
appearance  of  mirth  and  even  cheerfulness,  should 
be  avoided.  They  both  often  give  not  only  pain, 
but  offence,  to  a  mind  rendered  exquisitely  sensi- 
ble by  recent  grief. 

Physicians  are  sometimes  called  upon  to  men- 
tion the  deaths  of  relations  to  their  patients. 
This  should  never  be  done  at  once.  They  should 
be  first  told  that  they  were  sick,  and  in  great 
danger,  and  the  news  of  their  death  should  not 
be  communicated  until  after  a  second  or  third  visit. 

Of  Fear. 

There  are  so  much  danger  and  evil  in  our 
world,  that  the  passion  of  fear  was  implanted  in 


OP   THE    MIND.  323 

our  minds  for  the  wise  and  benevolent  purpose 
of  defending  us  from  them. 

The  objects  of  fear  are  of  two  kinds. 

I.  Reasonable.    These  are,  death,  and  surgi- 
cal operations.    And, 

II.  Unreasonable.    These  are,  thunder,  dark- 
ness, ghosts,  speaking  in  public,  sailing,  riding, 
certain  animals,  particularly  cats,  rats,  insects 
and  the  like. 

The  effects  of  fear,  when  it  acts  suddenly  upon 
the  system,  are  tremors,  quick  pulse  and  respira- 
tion, globus  hystericus,  a  discharge  of  pale  urine, 
diarrhoea,  and  sometimes  an  involuntary  dis- 
charge of  the  fa&ces,-  aphonia,  fever,  convulsions, 
syncope,  mania,  epilepsy,  asphyxia,  death.  Dr. 
Brambilla  relates  the  case  of  a  soldier,  in  whom 
fear  produced  not  only  a  fever,  but  a  mortifica- 
tion from  a  blister  on  the  leg,  which  destroyed 
his  life.  Besides  these  general  effects  of  fear,  it 
acts  in  a  peculiar  manner  upon  the  hair  of  the 
head.  1.  In  causing  it  to  stand  perpendicular. 
This  has  been  happily  described  by  Virgil  and 
Shakspeare.  2.  In  converting  it  suddenly  to  a 
gray  or  white  colour,  and,  3,  in  causing  it  to  come 


324  ON  THE  DISEASES 

out  by  the  roots,  and  to  fall  off  the  head.  Of  this 
Dr.  Huch  informed  me  he  knew  an  instance  in  a 
gentleman  who  was  in  Lisbon,  at  the  time  of  the 
great  earthquake  in  1755.  Other  effects  of  fear 
have  been  lately  noticed.  The  earthquake  which 
took  place  on  the  shores  of  the  Mississippi,  in 
December  1811,  produced  silence  or  great  talka- 
tiveness, and  moping  stillness  or  constant  mo- 
tion, in  different  people. 

The  remedies  for  fear  are  physical,  rational, 
and  moral ;  and  here,  as  in  the  preceding  chap- 
ter, I  shall  only  hint  at  the  moral  remedies,  and 
blend  them  with  such  as  are  of  a  rational  and 
physical  nature. 

I.  Of  the  remedies  for  the  reasonable  objects 
of  fear. 

The  first  object  of  fear  under  this  head  is  death. 
Its  remedies  are, 

1.  Just  opinions  of  the  divine  government,  and 
of  the  relation  we  sustain  to  the  great  Author  of 
our  being.  These  opinions  may  be  best  formed 
by  reading  the  scriptures,  and  such  other  books 
as  derive  their  arguments  for  fortifying  the  mind 
against  this  fear  from  them,  particularly  the  works 


OF  THE  MIND.  325 

of  Dr.  Sherlock  and  Mr.  Drelincourt,  both  of 
which  contain  a  treasure  of  knowledge  and  con- 
solation upon  this  subject. 

2.  As  much  of  the  fear  of  death  is  produced  by 
the  dread  of  the  pains  which  attend  it,  let  us  in- 
form our  patients  that  these  pains  are  by  no 
means  universal,  that  they  are  less  severe  than  the 
pains  of  many  common  diseases,  from  which  there 
are  daily  recoveries,  and  that  heaven  has  kindly 
furnished  us  with  several  remedies,  which  remove 
or  mitigate  them.    "  It  is  less  distressing  to  die 
(says  Mr.  Pascall)  than  to  think  of  death."    This 
I  believe  is  strictly  true  in  most  cases. 

3.  The  recollection  of  frequent  escapes  from 
death.    David  met  Goliah  without  fear,  when  he 
recollected  his  escapes  from  his  conflicts  with  a 
lion  and  a  bear.     Soldiers  become  brave,  in  pro- 
portion to  the  number  of  battles  they  have  sur- 
vived. 

4.  The  frequent  meditation  upon  death.     Dr. 
Horn  mentions  an  instance  of  a  man,  who  was 
not  only  cured  of  the  fear  of  death,  by  setting  a 
portion  of  time,  every  day,  to  meditate  upon  it, 
but  the  subject  at  length  became  agreeable  to 
him.    In  this,  as  well  as  in  many  other  instances, 


326  ON  THE  DISEASES 

painful  impressions  upon  the  mind  are  upon  a 
footing  with  painful  impressions  upon  the  body,  in 
being  converted  by  repetition  into  such  as  are  of 
a  pleasurable  nature. 

5.  CONSTANT  employment  is  an  antidote  to  the 
fear  of  death ;  for  fear,  like  vice,  is  the  offspring  of 
idleness. 

6.  We  have  an  account  of  a  method  of  obviat- 
ing the  fear  of  death  from  a  public  execution,  in 
Miss  Williams's  history  of  the   conduct  of  the 
Marquis  de  Chatelet,  and  General  Miranda,  du- 
ring their  confinement  in  Paris,  and  at  a  time 
when  they  expected  every  day  to  be  led  to  the 
guillotine.     They  read  books  of  history  and  sci- 
ence constantly  when  alone,  and  conversed  upon 
no  other  subjects  when  together ;  and  although 
they  were  confined  for  six  months  in  the  same 
apartment,  they  never  spoke  to  each  other  of 
their  impending  and    expected  fate,  by    which 
means  they  lessened  the  fear  of  it.    This  account 
was  confirmed  to  me  by  General  Miranda,  in  his 
visit  to  this  city  a  few  years  ago.     Boys  obviate 
fear,  in  like  manner,  by  silence  in  passing  by  a 
grave-yard,  or  by  conversing  upon  subjects  uncon- 
nected with  death.     It  is  not  peculiar  to  the  pas- 


OP  THE  MIND.  327 

sion  of  fear  to  be  increased  by  conversation.     All 
the  other  passions  arc  excited  by  it. 

7.  The  fear  of  death  is  sometimes  obviated  by 
company  in  the  last  hours  of  life.     "  Is  is  not  so 
difficult  a  thing  to  die  (said  Lewis  the  Fourteenth, 
on  his  death  bed)  as  I  expected."    Voltaire,  who 
mentions  this  anecdote,  endeavours  to  account 
for  it,  by  adding,  that  all  men  die  with  composure 
or  fortitude,  who  die  in  company.     The  courage 
of  soldiers  is  derived,  in  a  great  degree,  from  be- 
ing surrounded  by  persons  who  will  bear  a  testi- 
mony in  its  favour. 

8.  Music  suspends  the  fear  of  death  :  hence  its 
universal  use  in  battle.     Even  noise  of  any  kind 
dissipates  fear;  hence  boys  obviate  it  not  only  by 
silence  when  in  company,  but  by  whistling,  or  hal- 
looing when  they  pass  by  a  grave-yard  alone  after 
night. 

9.  OPIUM  has  a  wonderful  effect  in  lessening  the 
fear  of  death.    I  have  seen  patients  cheerful  in 
their  last  moments,  from  the  operation  of  this 
medicine  upon  the  body  and  mind. 

10.  The  fear  of  a  surgical  operation  may  be 
very  much  lessened  by  previous  company,  and  a 


328  ON  THE  DISEASES 

large  dose  of  opium.  Its  pain  may  be  mitigated 
by  the  gradual  application  of  the  knife,  and,  in 
tedious  operations,  by  short  intermissions  in  the 
use  of  it. 


II.  Of  the  unreasonable  objects  of  fear.   These 


are, 


1.  Thunder.    The  remedies  for  it  are, 

1.  Living  in  a  house  defended  by  a  lightning 
rod. 

2.  Sitting  in  the  middle  of  a  room,  and  remote 
from  the  doors  and  windows  of  a  house,  not  de- 
fended by  a  lightning  rod. 

3.  A  citizen  of  Philadelphia,  who  was  under 
the  influence  of  this  fear,  obviated  it  in  a  degree 
by  closing  the  doors  and  windows  of  a  room,  and 
sitting  with  a  lighted  candle  in  it.    By  this  means 
he  avoided  the  sight  of  the  lightning,   and  the 
anticipation  of  the  noise  of  the  thunder  which 
usually  follows  it. 

4.  A  lady  of  respectable  character,  formerly  of 
this  city,  usually  fainted  with  terror  during  the  time 
of  a  thunder-gust,  and  discovered,  by  a  livid  coun- 
tenance, and  cold  and  clammy  sweats,  the  signs  of 


OP  THE  MIND.  329 

approaching  death.  She  was  apparently  kept 
alive,  by  pouring  into  her  stomach  three  or  four 
wine  glasses  of  Jamaica  spirits :  it  was  remarka- 
ble she  never  was  intoxicated  by  it,  and  that  it 
was  disagreeable  to  her  at  all  other  times. 

5.  I  crossed  the  Atlantic  Ocean  with  a  lady,  in 
whom  an  acute  headach  was  always  induced  by 
thunder.  It  left  her  as  soon  as  the  thunder 
ceased.  Her  only  remedies  for  it,  were  quietness 
and  silence.  It  is  probable  a  large  dose  of  lauda- 
num, taken  upon  the  appearance  of  a  thunder- 
gust,  would  have  prevented  this  headach,  as  well 
as  obviated  the  terror  mentioned  in  the  two  pre- 
ceding cases,  more  effectually  than  a  close  room 
artificially  lighted,  or  a  large  quantity  of  ardent 
spirits. 

2.  The  fear  which  is  excited  by  darkness,  may 
easily  be  overcome  by  a  proper  mode  of  educa- 
tion in  early  life.     It  consists  in  compelling  chil- 
dren to  go  to  bed  without  a  candle,  or  without 
permitting  company  to  remain  with  them  until 
they  fall  asleep. 

3.  The  fear  of  ghosts  should  be  prevented  or 
subdued  in  early  life,  by  teaching  children  the  ab- 

42 


330  ON  THE  DISEASES 

surdity  and  falsehood  of  all  the  stories  that  are 
fabricated  by  nurses  upon  that  subject. 

4.  The  fear  from  speaking  in  public  was  always 
obviated  by  Mr.  John  Hunter,  by  taking  a  dose  of 
laudanum  before  he  met  his  class  every  day. 

5.  The  fear  from  sailing,  riding,  and  from  cer- 
tain animals  and  insects,  may  all  be  cured  by  re- 
solution.   It  should  be  counteracted  in  early  life. 
The  existence  of  it  always  shows  a  defective  edu- 
cation.   Peter  the  Great,  of  Moscovy,  was  born 
with  a  dread  of  water.    He  cured  it,  by  throwing 
himself  headlong  into  a  boat  when  obliged  to 
cross  a  river.     The  horror  he  felt  in  doing  this 
often  induced  syncope.     He  finally  conquered  his 
dread  of  water,  so  as  to  cross  seas  in  pursuit  of 
the  great  objects  which  characterized  his  life  and 
reign. 

In  cases  of  sudden  fear  from  any  cause,  holding 
the  breath,  coughing,  or  hawking,  often  give  im- 
mediate relief.  They  impart  tone  to  the  brain, 
by  promoting  a  determination  of  blood  to  it,  and 
thus  infuse  vigour  into  the  mind. 

To  obviate  fear  from  all  its  causes,  great  ad- 
vantages will  arise  from  creating  counter  motives 


OP  THE  MIND.  331 

in  the  mind.  The  fear  of  death  in  a  battle  is 
overcome  by  the  powerful  sense  of  glory,  or 
shame.  The  fear  of  the  pain  of  an  operation, 
such  as  drawing  a  tooth  in  a  child,  is  overcome 
by  the  expectation  of  receiving  afterwards  a  piece 
of  money,  and  the  prospect  of  all  the  pleasures  it 
will  procure. 

Great  advantages  may  likewise  be  derived  for 
the  cure  of  fear,  by  a  proper  application  of  the 
principle  of  association.  A  horse  will  seldom  be 
moved  by  the  firing  of  a  gun,  or  the  beating  of  a 
drum,  if  he  hear  them  for  the  first  time  while  he 
is  eating;  nor  will  he  start,  or  retire  from  a 
wheel-barrow,  or  a  millstone,  or  any  other  object 
of  that  kind,  after  being  once  or  twice  fed  upon 
them.  The  same  law  of  association  may  be  ap- 
plied in  a  variety  of  instances  to  the  human  mind, 
as  well  to  the  prevention,  as  cure  of  fear. 

Of  Anger. 

This  passion  was  implanted  in  the  human  mind 
for  wise  and  useful  purposes.  Its  exercises,  with- 
in certain  limits,  are  admitted  in  the  scriptures. 
It  is  only  when  it  ascends  to  rage  and  fury,  or 
when  it  is  protracted  into  malice  and  revenge, 
that  it  becomes  a  sin  and  a  disease. 


332  ON  THE  DISEASES 

A  morbid  paroxysm  of  anger  appears  in  a  pre- 
ternatural determination  of  blood  to  the  brain,  a 
turgescence  of  the  blood-vessels  of  the  face,  a 
redness  of  the  eyes,  an  increased  secretion  of 
saliva,  which  is  discharged  by  foaming  at  the 
mouth,  great  volubility  or  a  total  suppression  of 
speech,  agitations  of  the  fists,  stamping  of  the  feet, 
uncommon  bodily  strength,  convulsions,  hysteria, 
bleeding  at  the  nose,  apoplexy  and  death.  Some- 
times this  disease  appears  with  paleness,  tremors, 
sickness  at  the  stomach,  quick  respiration, 
puking,  syncope  and  asphyxia.  It  is  in  this  case 
generally  combined  with  fear,  and  hence  arises 
the  abstraction  of  blood  from  the  brain,  and  its 
determination  to  other  parts  of  the  body. 

The  remedies  for  anger,  when  it  becomes  a 
disease,  divide  themselves  into  two  classes;  I. 
such  as  are  proper  during  its  paroxysms ;  and  II. 
such  as  are  proper  in  their  intervals,  to  prevent 
their  recurrence. 

I.  To  the  first  head  belong, 

1.  A  draught  of  COLD  WATER.  This  acts  in  two 
ways ;  I,  as  a  sedative ;  and  2,  by  giving  time  for 
reflection. 


OF  THE  MIND.  333 


2.  COLD  WATER  thrown  over  the  whole  body 
has  in  several  instances   cured  a  paroxysm  of 
anger.    It  never  fails  to  part  two  angry,  contend- 
ing dogs. 

•  •  .  i-  •  ,  •  , 

3.  SILENCE.     This  should  be  observed  by  per- 
sons, when  they  are  disposed  to  excessive  anger. 
If  this  be  impracticable,  let  the  angry  person 
repeat  the  Lord's  prayer ;  or,  if  he  be  indisposed 
to  do  this,  let  him  count  twenty.     The  actions  of 
the  organs  of  speech,  employed  in  either,  will 
serve  to  convey  off  a  portion  of  excitement  from 
his  mind,  as  well  as  to  give  time  for  the  reflux  of 
blood  from  the  brain. 

4.  The  celebrated  general  Galvez,  formerly  of 
the  Spanish  army,  made  it  a  practice,  when  he 
felt  himself  disposed  to  be  angry,  to  drink  a  bot- 
tle of  claret.  It  instantly  composed  his  mind,  pro- 
bably by  overcoming  a  weak  morbid  action,  and 
producing  agreeable  and  healthy  excitement  in 
his  brain.     A  dose  of  laudanum  would  be  a  better 
remedy  for  this  purpose.     It  could  not  fail  of  be- 
ing effectual  in  anger  attended  with  fear,  and  a 
determination  of  the  blood  to  the  stomach  and 
viscera  of  the  thorax. 


334  OX  THE  DISEASES 

II.  The  means  of  preventing  the  recurrence  of 
anger  shouldrbe, 

1.  A  milk  and  vegetable  diet.    Dr.  Arbuthnot 
says  he  has  seen  an  irascible  diathesis  perfectly 
cured  by  this  remedy. 

2.  Avoiding  speaking  with  a  loud  voice  at  all 
times,  and  especially  when  disposed  to  anger. 

3.  Avoiding  the  use  of  ardent  and  fermented 
liquors.     They  predispose  to  anger,  even  where 
they  do  not  intoxicate. 

4.  Ballonius  says,  that  fatigue  and  thirst  pre- 
dispose to  anger.     Hunger    certainly  has  that 
effect.     They  should  both  therefore  be  carefully 
avoided  by  irascible  persons. 

5.  Opposing  to  anger  other  passions  which  de- 
stroy it.    Thetys,  I  remarked  formerly,  eradicated 
the  anger  of  her  son  Achilles,  by  exciting  in  his 
mind  the  passion  of  love.     Fear  has  had  the  same 
effect.     The  threat  and  the  dread  of  a  severe 
punishment  has  often  prevented  it  in  school  boys 
and  servants. 


OF  THE  MIND.  335 

6.  The  cultivation  of  the  understanding  has  a 
great  influence  in  destroying  the  predisposition  to 
anger.  Science  of  all  kinds  is  useful  for  this  pur- 
pose, but  the  mathematics  possess  this  property 
in  the  most  eminent  degree.  They  produced  that 
effect  upon  the  temper  of  Sir  Isaac  Newton,  of 
which  the  following  instance  is  mentioned  by  one 
of  his  cotemporaries. 

Upon  seeing  a  large  collection  of  papers  on  fire 
that  contained  the  calculations  of  many  years,  in 
consequence  of  his  little  dog  jumping  upon  his 
table  and  oversetting  his  candle  upon  them,  he 
barely  uttered  the  following  words ;  "  O  !  Dia- 
mond !  Diamond !  little  dost  thou  know  the  mis- 
chief thou  hast  done  thy  master."  I  shall  men- 
tion in  another  place  an  instance  of  one  of  his 
appetites  being  subdued  in  like  manner,  by  his 
mind  being  constantly  occupied  by  mathematical 
and  philosophical  studies.  I  am  disposed  to 
ascribe  more  to  those  studies  than  to  any  others, 
from  their  extending  a  sedative  and  moral  influ- 
ence to  all  the  passions.  The  late  Rev.  Mr. 
Farmer,  one  of  the  ministers  of  the  Catholic 
church  in  this  city,  informed  me  that  demonstating 
two  or  three  propositions  in  Euclid,  before  he 
retired  to  his  closet  for  the  purpose  of  devotion, 
never  failed  to  have  that  effect  upon  his  mind. 


336 


ON  THE  DISEASES 


7.  It  will  be  useful  for  persons  subject  to  the 
criminal  degrees  of  this  passion,  to  reflect  that  it 
is  not  only  contrary  to  religion  and  morals,  but 
to  liberal  manners.  The  term  gentleman  implies 
a  command  of  this  passion,  above  all  others. 

Of  Joy.  .-..,;,,, 

This  emotion  is  attended  sometimes  with  pain 
in  the  region  of  the  heart,  a  change  in  the  voice, 
tears,  syncope,  and  death.  Mr.  Bruce  mentions 
another  symptom  of  excessive  joy,  and  that  is 
thirst,  which  he  felt  in  a  high  degree,  when  he 
reached  the  long  sought  for  head  of  the  Nile.  He 
gratified  it,  he  tells  us,  by  drinking  the  health  of 
his  sovereign,  George  the  Third,  and  of  his  mis- 
tress,  by  a  draught  from  the  fountain  of  that  cele- 
brated river. 

Joy  is  most  intense,  when  it  has  been  preceded 
by  fear.  The  Indian  Chief,  Logan,  has  desig- 
nated this  form  of  joy  in  his  eloquent  speech,  pre- 
served by  Mr.  Jefferson,  in  his  Notes  upon  Virgi- 
nia, when  he  declares  that  "  he  knew  not  the  joy 
of  fear." 

There  are  many  instances  upon  record,  of  death 
being  induced  by  a  sudden  paroxysm  of  joy.  The 


OF  THE  MIND.  337 

son  of  the  famous  Leibnitz  died  from  this  cause, 
upon  his  opening  an  old  chest,  and  unexpectedly 
finding  in  it  a  large  quantity  of  gold.  Joy,  from 
the  successful  issue  of  political  schemes  or 
wishes,  has  often  produced  the  same  effect.  Pope 
Leo  the  Tenth  died  of  joy,  in  consequence  of 
hearing  of  a  great  calamity  that  had  befallen  the 
French  nation.  Several  persons  died  from  the 
same  cause,  Mr.  Hume  tells  us,  upon  witnessing 
the  restoration  of  Charles  the  Second  to  the  Bri- 
tish throne ;  and  it  is  well  known  the  door-keeper 
of  Congress  died  of  an  apoplexy,  from  joy,  upon 
hearing  the  news  of  the  capture  of  Lord  Corn- 
wallis  and  his  army,  during  the  American  revolu- 
tionary war. 

During  a  paroxysm  of  joy,  if  it  be  attended  with 
danger  to  life,  a  new  emotion  or  passion  should 
be  excited,  particularly  terror,  anger,  fear,  or  grief. 
Perhaps  the  affusion  of  cold  water  might  have 
that  effect.  The  stimulus  of  artificial  pain  should 
likewise  be  tried.  It  should  be  of  a  nature  calcu- 
lated to  produce  the  most  prompt  effects. 

The  morbid  state  of  joy  should  be  prevented, 
by  imparting  the  news  which  we  expect  will 
create  it,  in  a  gradual  manner,  and  with  the  alloy 
of  some  unpleasant  circumstances. 

43 


338  ON  THE  DISEASES 

Connected  with  joy,  but  produced  by  different 
causes,  is  LAUGHTER.  It  is  a  convulsive  disease, 
and  sometimes  induces  a  rupture  of  a  blood- 
vessel in  the  lungs,  spleen,  or  brain.  I  have  seen 
an  instance  of  haemoptysis  induced  by  it,  which 
had  a  fatal  issue.  Two  sudden  deaths  are  upon 
record  from  it,  the  one  of  Chrysippus,  an  ancient 
Greek  philosopher,  the  other  of  a  pope.  It  was 
induced  in  the  latter,  while  he  was  confined  to  his 
bed  with  a  light  indisposition,  by  seeing  a  tame 
monkey  put  on  a  part  of  his  pontifical  robes. 
Excessive  laughter,  when  not  attended  with  these 
fatal  effects,  is  often  followed  with  a  pain  in  the 
left  side,  hiccup,  and  low  spirits. 

The  remedies  for  a  paroxysm  of  laughter 
should  be,  fear,  terror,  or  any  other  counter  im- 
pression. Pinching  the  body,  or  the  affusion  of 
cold  water  over  it,  is  calculated  to  produce  the 
same  good  effects.  Laudanum  seldom  fails  of 
relieving  the  pain,  hiccup,  and  low  spirits,  which 
sometimes  follow  it. 

Of  the  Morbid  Effects  of  Envy,  Malice,  and 
Hatred. 

As  envy  is  commonly  the  parent  of  malice  and 
hatred,  I  shall  make  a  few  remarks  upon  it,  and 


OF  THE  MIND.  339 

afterwards  mention  the  combined  effects  of  them 
all  upon  the  body. 

Of  this  vice  it  may  be  truly  asserted,  that  it  is 
deep  seated,  and  always  painful;  hence  it  has 
been  said,  by  an  inspired  writer,  to  resemble 
"rottenness  in  the  bones;"  and  by  Lord  Bacon, 
"  to  know  no  holidays."  It  is  likewise  a  monopo- 
lizing vice.  Alexander  envied  his  successful  gene- 
rals, and  Garrick  was  hostile  to  all  the  popular 
players  of  his  day.  It  is  moreover  a  parricidal 
vice,  for  it  not  only  emits  its  poison  against  its 
friends,  but  against  the  persons,  who,  by  the 
favours  it  has  conferred  upon  those  who  cherish 
it,  have  become  in  one  respect  the  authors  of 
their  being;  and,  lastly,  it  possesses  a  polypus 
life.  No  kindness,  gentleness,  or  generosity,  can 
destroy  it.  On  the  contrary,  it  derives  fresh 
strength  from  every  act  which  it  experienced  of 
any  of  them.  It  likewise  survives  and  often  for- 
gives the  resentment  it  sometimes  occasions,  but 
without  ceasing  to  hate  the  talents,  virtues,  or  per- 
sonal  endowments,  by  which  it  was  originally  ex- 
cited. Nor  is  it  satiated  by  the  apparent  extinc- 
tion of  them  in  death.  This  is  obvious,  from 
its  so  frequently  opening  the  sanctuary  of  the 
grave,  and  robbing  the  possessors  of  those  quali- 
ties of  the  slender  remains  it  had  left  them  of 
posthumous  fame. 


340  ON  THE  DISEASES 


However  devoid  this  vice  and  its  offspring  may 
be  of  remissions,  they  now  and  then  appear  in  the 
form  of  paroxysms,  which  discover  themselves  in 
tremors,  paleness,  and  a  suffusion  of  the  face  with 
red  blood.  The  face  in  this  case  performs  the 
vicarious  office  which  has  lately  been  ascribed  to 
the  spleen.  But  their  effects  appear  more  fre- 
quently in  slow  fevers,  and  in  a  long  train  of  ner- 
vous diseases.  Persons  affected  with  them  sel- 
dom acknowledge  their  true  cause.  A  single  in- 
stance only  of  this  candour  is  mentioned  by  Dr. 
Tissot.  He  tells  us  he  was  once  consulted  by  a 
gentleman,  who  told  him  all  his  complaints  were 
brought  on  by  his  intense  and  habitual  hatred  of 
an  enemy.  Many  of  the  chronic  diseases  of  high 
life,  and  professional  men,  I  have  no  doubt,  are 
induced  by  the  same  cause. 

I  once  thought  that  medicine  had  not  a  single 
remedy  in  all  its  stores,  that  could  subdue  or  even 
palliate  the  diseases  induced  by  the  baneful  pas- 
sions that  have  been- described,  and  that  an  anti- 
dote to  them  was  to  be  found  only  in  religion;  but 
I  have  since  recollected  one,  and  heard  of  another 
physical  remedy,  that  will  at  least  palliate  them. 
The  first  is,  frequent  convivial  society  between 
persons  who  are  hostile  to  each  other.  It  never 
fails  to  soften  resentments,  and  sometimes  to  pro- 


OF  THE  MIND.  341 

duce  reconciliation,  and  friendship.  The  reader 
will  be  surprised,  when  I  add,  that  the  second  phy- 
sical remedy  was  suggested  to  me  by  a  madman 
in  the  Pennsylvania  Hospital.  In  conversing  with 
him,  he  produced  a  large  collection  of  papers, 
which  he  said  contained  his  Journal.  "  Here 
(said  he)  I  write  down  every  thing  that  passes  in 
my  mind,  and  particularly  malice  and  revenge. 
In  recording  the  latter,  I  feel  my  mind  emptied  of 
something  disagreeable  to  it,  just  as  a  vomit 
empties  the  stomach  of  bile.  When  I  look  at 
what  I  have  written  a  day  or  two  afterwards,  I 
feel  ashamed  and  disgusted  with  it,  and  wish  to 
throw  it  into  the  fire."  I  have  no  doubt  of  the 
utility  of  this  remedy  for  envy,  malice,  and  hatred, 
from  its  salutary  effects  in  a  similar  case.  A  gen- 
tleman in  this  city  informed  me,  that  after  writing 
an  attack  for  the  press  upon  a  person  who  had 
offended  him,  he  was  so  struck  with  its  malignity, 
upon  reading  it,  that  he  instantly  destroyed  it. 
The  French  nobility  sometimes  cover  the  walls 
and  ceiling  of  a  room  in  their  houses  with  look- 
ing glasses.  The  room,  thus  furnished,  is  called 
a  boudoir.  Did  ill-natured  people  imitate  the 
practice  of  the  madman  and  the  gentleman  I  have 
mentioned,  by  putting  their  envious,  malicious, 
and  revengeful  thoughts  upon  paper,  it  would 


342  ON  THE  DISEASES 

form  a  mirror,  that  would  serve  the  same  purpose 
of  pointing  out,  and  remedying,  the  evil  disposi- 
tions of  the  mind,  that  the  boudoirs  in  France 
serve,  in  discovering  and  remedying  the  defects 
in  the  attitudes  and  dress  of  the  body. 

To  persons  who  are  not  ashamed,  nor  disgust- 
ed, with  the  first  sight  of  their  malevolent  effu- 
sions upon  paper,  the  same  advice  may  be  given, 
that  Dr.  Franklin  gave  to  a  gentleman,  who  read 
part  of  a  humorous  satire  which  he  had  written 
upon  the  person  and  character'  of  a  respectable 
citizen  of  Philadelphia.  After  he  had  finished 
reading  it,  he  asked  the  Doctor  what  he  thought 
of  his  publishing  it.  "Keep  it  by  you,"  said  the 
Doctor,  "  for  one  year,  and  then  ask  me  that 
question."  The  gentleman  felt  the  force  of  this 
answer,  and  went  immediately  to  the  printer,  who 
had  composed  the  first  page  of  it,  took  it  from 
him.  and  consigned  the  whole  manuscript  to 
oblivion. 

I  shall  conclude  the  history  of  the  passions,  by 
remarking,  that  their  symptoms,  and  force,  are 
varied  by  a  difference  in  predisposition,  age,  rank 
in  society,  profession,  moral  and  religious  habits, 
duration,  and  by  their  acting  singly,  or  in  combi- 
nation with  each  other. 


OF  THE  MIND.  343 

There  is  now  and  then  a  TORPOR  OF  THE  PAS- 
SIONS, the  reverse  of  the  diseases  in  them  which 
have  been  described.  Instead  of  being  unduly 
excited,  they  are  devoid  of  all  sensibility  and  irri- 
tability. Persons  who  are  thus  affected  love  and 
fear  nothing.  They  are  strangers  to  grief  and 
anger;  they  envy  and  hate  nobody;  and  they  are 
alike  insensible  to  mental  pleasure  and  pain.  1 
was  once  consulted  by  a  citizen  of  Philadelphia, 
who  was  remarkable  for  his  strong  affection  for 
his  wife  and  children  when  his  mind  was  in  a 
sound  state,  who  was  occasionally  afflicted  with 
this  apathy,  and  when  under  its  influence  lost  his 
affection  for  them  all,  so  entirely,  that  he  said  he 
could  see  them  butchered  before  his  eyes  without 
feeling  any  distress,  or  even  an  inclination  to  rise 
from  his  chair  to  protect  them. 

This  paralytic  state  of  all  the  passions  con- 
tinues during  life  in  some  people;  a  physician  of 
great  eminence,  who  died  some  years  ago  in  Eng- 
land, declared,  upon  his  death-bed,  that  he  had 
never  known  what  it  was  to  love  man,  woman  or 
child.  But  we  sometimes  meet  with  this  disorder  in 
a  partial  state.  Thus,  there  are  men  who  have 
never  loved,  others  who  have  never  feared,  others 
who  have  never  shed  a  tear,  and  others  in  whom 
no  injuries  have  ever  excited  an  emotion  of  anger. 


344  ON  THE  DISEASES 

In  such  persons,  the  mind  is  in  a  mutilated  state ; 
for  man,  without  all  his  passions,  is  an  imperfect 
being,  both  as  to  his  duties  and  happiness. 

The  remedies  for  this  torpid  state  of  the  pas- 
sions, whether  general  or  partial,  should  be  suited 
to  the  state  of  the  system.  Depletion  will  be  pro- 
per, if  the  blood-vessels  are  oppressed.  In  a 
contrary  state  of  the  system,  powerful  stimulants 
particularly  pain,  labour,  the  cold  bath,  and  a 
salivation,  are  indicated.  I  mentioned  formerly 
an  instance  in  which  mercury  restored  the  affec- 
tion of  a  mother  for  her  child  in  a  day  or  two 
after  it  affected  her  mouth. 


OF  THE  MIND.  345 


CHAPTER  XVIII. 


Of  the  Morbid  State  of  the  Sexual  Appetite. 

THIS  appetite,  which  was  implanted  in  our  na- 
tures for  the  purpose  of  propagating  our  species, 
when  excessive,  becomes  a  disease  both  of  the 
body  and  mind.     When  restrained,  it  produces 
tremors,  a  flushing  of  the  face,  sighing,  nocturnal 
pollutions,  hysteria,  hypochondriasis,  and  in  wo- 
men the  furor  uterinus.     When  indulged   in   an 
undue   or  a  promiscuous  intercourse   with   the 
female  sex,  or  in  onanisrn,  it  produces  seminal 
weakness,  impotence,  dysury,  tabes  dorsalis,  pul- 
monary consumption,  dyspepsia,  dimness  of  sight, 
vertigo,  epilepsy,   hypochondriasis,  loss  of  me- 
mory, manalgia,  fatuity  and  death.    From  a  num- 
ber of  letters  addressed  to  me,  for  advice,  I  shall 
select  but  three,  in  which  many  of  those  symp- 
toms are  mentioned,  and  deplored  in  the  most 
pathetic  terms.     The  first  is  from  a  physician  in 
Massachusetts,  dated  September  4th,  1793. 

44 


346  ON  THE  DISEASES 

"  The  gentleman,  whose  case  is  now  submitted 
to  you,  is  about  twenty-five  years  of  age,  meagre, 
gloomy,  and  restless,  has  a  bad  countenance,  and 
a  lax  state  of  bowels.  He  imputes  his  indisposi- 
tion to  his  excessive  devotedness  to  Venus,  which 
he  thinks  has  been  induced  by  a  morbid  state  of 
his  body.  He  has  been  married  three  years,  had 
no  connection  with  the  sex  before  he  married, 
and,  although  he  feels  disgusted  with  his  strong 
venereal  propensities,  he  cannot  resist  them.  I 
advised  him  to  separate  himself  from  his  wife  by 
traveling,  which  he  did,  but  without  experiencing 
any  relief  from  his  disease.  He  has  earnestly 
requested  me  to  render  him  impotent,  if  I  could 
not  give  him  the  command  of  himself  in  any  other 
way.  I  have  tried  several  remedies  in  his  case ; 
nothing  has  done  him  any  good  except  the  sugar 
of  lead,  which  I  was  soon  obliged  to  lay  aside, 
from  its  producing  a  severe  nervous  cholic. 
Wishing  to  know  whether  his  disease  was  not 
seated  in  his  imagination  only,  I  asked  whether 
the  gratification  of  his  appetite  was  equal  to  his 
desires.  Dixit,  per  annos  tres,  quinque  vices  se 
coitum  fecisse  in  horis  viginti  quatuor,  et  semper 
semine  ejecto." 

The  second  letter,  to  which  I  have  alluded,  is 
from  the  miserable  subject  of  the  disease  that  is 


OF  THE  MIXD.  347 

described  in  it.  After  acknowledging  its  cause  to 
be  from  onanism,  he  adds,  "I  rest  badly  at  nights, 
and  am  much  troubled  with  dreams.  I  have  fre- 
quent nocturnal  erections,  accompanied  with  a 
sensation  of  uneasiness,  instead  of  desire  or  plea- 
sure ;  and  from  dreams,  frequent  emissions  take 
place,  which  are  much  more  fluid  than  natural. 
The  external  organs  of  generation  have  a  numb, 
or  dead  feeling.  The  lower  part  of  my  back  is 
weak ;  my  eyes  are  often  painful  and  my  eye-lids 
swelled  and  red.  I  have  an  almost  constant  cold, 
and  oppression  at  my  stomach.  In  short,  I  had 
rather  be  laid  in  the  silent  tomb,  and  encounter 
that  dreadful  uncertainty,  hereafter,  than  remain  in 
my  present  unhappy  and  degraded  situation. 
These  are  humiliating  concessions,  and  it  is 
extremely  painful  for  me  to  make  them ;  but  let 
my  melancholy  situation  be  my  apology  for 
them." 

The  third  and  last  letter  upon  this  subject  is 
from  a  physician  in  Virginia,  in  which  he  de- 
scribes the  disease  of  a  patient  then  under  his 
care,  in  the  following  words.  "  A.  B.  aged  seven- 
teen, of  a  cold  phlegmatic  temperament  of  body, 
of  a  sedentary  life,  and  studious  habits,  in  conse- 
quence of  indulging  in  the  solitary  vice  of  onan- 
ism, has  lately  become  very  much  diseased.  His 


348  ON  THE  DISEASES 

vision  is  indistinct,  and  his  memory  much  impair- 
ed, and  he  now  labours  under  much  muscular 
relaxation,  prostration  of  strength,  atrophy,  and 
depression  of  spirits.  His  system  is  so  very  irri- 
table, that  the  least  agitation  of  mind,  or  riding 
on  horseback,  or  gently  rubbing  his  breast,  or 
even  combing  his  hair,  seminis  ernissionem  indu- 
cunt.  Any  plan  you  may  suggest  for  the  relief  of 
this  truly  wretched  being  will  be  gratefully  re- 
ceived." 

But  these  are  not  all  the  melancholy  and  dis- 
gusting effects  of  excess  in  the  indulgence  of  the 
sexual  appetite.  They  sometimes  discover  them- 
selves in  the  imagination  and  senses,  in  a  fond- 
ness for  obscene  conversation  and  books,  and  in 
a  wanton  dalliance  with  women,  long  after  the 
ability  to  gratify  the  appetite  has  perished  from 
disease  or  age. 

The  remote  and  exciting  causes  of  this  disease 
in  the  sexual  appetite  are, 

1.  Excessive  eating,  more  especially  of  high 
seasoned  animal  food.  The  vices  of  the  cities  of 
the  plain  were  derived  in  part  from  their  "  fulness 
of  bread ;"  by  which  is  meant  an  excess  of  nour- 
ishing aliment. 


OF  THE  MIND.  349 

2.  Intemperance  in  drinking.     Hence  the  fre- 
quent transition  from  the  bottle  to  the  brothel ! 
It  is  because  it  is  so  common  and  natural,  that  the 
former  is  generally  mentioned  as  an  apology  for 
the  disease  contracted  in  the  latter,  by  young 
men,  in  their  application  to  physicians  for  reme- 
dies for  it.     The  incestuous  gratification  of  the 
sexual  appetite,  which  was  the  first  sin  that  re- 
vived in  the  world  after  the  flood,  was  the  effect, 
we  are  told,  of  the  intemperate  use  of  wine. 

3.  Idleness.     This  was  another  of  the  causes 
mentioned  in  the  Old  Testament  of  the  vices  of 
the  cities  of  the  plain.     It  is  from  the  effects  of 
indolence  and  sedentary  habits  that  the  venereal 
appetite  prevails  with  so  much  force,  and  with 
such   odious  consequences,  within  the  walls  of 
those  seminaries  of  learning,  in  which  a  number 
of  young  men  are  herded  together,  and  lodge  in 
the  same  rooms,  or  in  the  same  beds. 

The  remedies  for  this  appetite,  when  inordi- 
nate, are  natural,  physical  and  mental.  They  are, 

1.  Matrimony;  but  where  this  is  not  practica- 
ble, the  society  of  chaste  and  modest  women. 
While  men  live  by  themselves  (says  La  Brtiyere) 
they  do  not  view  washerwomen  or  oyster-wenches 


350  ON  THE  DISEASES 

as  washerwomen  or  oyster-wenches,  but  simply 
as  women.  But  by  mixing  with  the  sex,  they 
lose  the  habit  of  associating  the  idea  of  the  sex 
of  the  woman  with  a  cap  or  a  petticoat.  I  have 
known  few  young  men  of  loose  morals,  who  have 
attached  themselves  to  the  society  of  the  ladies. 
They  not  only  polish  their  manners,  but  purify 
their  imaginations. 

2.  A  diet,  consisting  simply  of  vegetables,  and 
prepared  without  any  of  the  usual  condiments  that 
are  taken  with  them.  Dr.  Stark  found  his  vene- 
real desires  nearly  extinguished  by  living  upon 
bread  and  water.  They  revived  upon  a  diet  of 
bread  and  milk,  and  became  more  active  by  eat- 
ing six  or  eight  ounces  of  roasted  goose  every 
day,  with  a  proportionable  quantity  of  bread. 
Persons  afflicted  with  this  disease  should  use  but 
little  salt  in  their  aliment.  Plutarch  tells  us,  it 
was  avoided  by  the  priests  in  his  day,  from  its  dis- 
posing to  venery.  The  birth  of  Venus  from  the 
sea  was  probably  intended  to  signify  the  connec- 
tion between  the  use  of  salt  and  the  venereal 
appetite.  In  recommending  a  vegetable  diet  for 
the  cure  of  this  disease,  I  would  remark,  that  it 
is  effectual  only  when  it  succeeds  a  full  animal 
diet;  for  we  read  not  only  of  individuals,  but  of 
whole  nations,  that  live  upon  vegetables  and 


OF  THE  MIND.  351 

other  simple  food,  in  whom  the  sexual  appetite 
exists  in  its  usual  and  natural  force.  In  such  per- 
sons the  appetite  should  be  weakened,  by  reduc- 
ing the  quantity  of  their  aliment. 

3.  Temperance  in  drinking,  or  rather  the  total 
abstinence  from  all  fermented  and  distilled  liquors. 

4.  Constant  employment  in  bodily  labour  or 
exercise.     They  both  lessen  venereal  excitability 
and   promote  healthy  excitement.     Hippocrates 
tells  us,  the   Scythians,   who  nearly  lived  upon 
horseback,  were  free  from  venereal  desires.  Long 
journeys   on  horseback,  should  therefore  be  re- 
commended for  the  morbid  degrees  of  this  appe- 
tite.    The  chase  would  probably  serve  the  same 
purpose.     The  connection  between  this  exercise 
and  chastity  is  happily  illustrated  by  the  poets  in 
the   character   of  Diana,  who  lived  by  hunting. 
The  Indians  owe  the  weakness  of  their  venereal 
desires  to  this,  among  other  invigorating  employ- 
ments. 

5.  The  cold  bath.     There  is  a  debility  of  body 
which  is  connected  with  venereal  excitability,  and 
which  the  cold  bath  is  calculated  to    remove. 
This  excitability  is  most  apt  to  occur  during  the 
convalescence,  or  soon  after  the  recovery  from 


•v- 


\ 

352  ON  THE  DISEASES 

malignant  or  chronic  fevers.  Twelve  marriages 
took  place  of  the  patients  who  recovered  from  the 
yellow  fever  at  Bush-hill,  in  the  neighbourhood  of 
this  city,  in  the  year  1793;  and  a  greater  num- 
ber were  detected  in  a  criminal  intercourse  with 
each  other,  in  the  private  apartments  and  tents 
belonging  to  the  hospital.  I  have  known  two  in- 
stances of  young  clergymen,  who  married  the  wo- 
men who  nursed  them  in  chronic  fevers,  both  of 
whom  were  in  very  humble  life.  The  celebrated 
Mr.  Howard  did  the  same  thing.  These  unequal 
matches  appear  to  have  been  the  effects  of  a 
morbid  sexual  appetite,  that  suddenly  succeeded 
their  fevers,  and  which  they  did  not  dare  to  gra- 
tify but  in  a  lawful  way. 

6.  A  salivation,  by    diverting  morbid   excita- 
bility from  the  genitals  to  the  mouth  and  throat, 
would  probably  be  useful  in  this  disease. 

7.  Avoiding  all  dalliance  with  the  female  sex. 
I  knew  a  gentleman  in  this  city,  who  assured  me 
he  had  gained  a  complete  victory  over  his  vene- 
real desires  by  a  strict  regard  to  this  direction ; 
and  I  have  heard  of  a  clergyman,  who  overcame 
this  appetite  by  never  looking  directly  in  the  face 
of  a  woman. 


OP  THE  MIND.  353 

8.  Avoiding  the  sight  of  obscene  pictures,  the 
reading  obscene  books,  and  listening  to  obscene 
conversation,  all  of  which  administer  fuel  to  the 
sexual  appetite. 

9.  Certain  tones  of  music  have  sometimes  sud- 
denly relieved  a  paroxysm  of  venereal  desires. 

10.  Dr.  Boerhaave  says  a  sudden  fit  of  laughter 
has  sometimes  had  the  same  effect. 

11.  Close  application  of  the  mind  to  business, 
or  study  of  any  kind,  more  especially  to  the  ma- 
thematics.    Sir  Isaac  Newton  conquered  this  ap- 
petite by  means  of  the  latter  study,  and  the  late 
Dr.  Fothergill  by  constant  application  to  business. 
Both  these  great  and  good  men  lived  and  died 
bachelors,  and  both  declared,  upon  their  death 
beds,  that  they  never 'had  known,  in  a  single  in- 
stance, a  criminal  connection  with  the  female  sex. 

12.  The    influence  of  an  active  passion,  that 
shall  predominate  over  the  sexual  appetite.    The 
love  of  military  glory,  so  common   among  the 
American  Indians,  by  combining  with  the  hard- 
ships of  a  savage  life,  contributes  very  much  to 
weaken  their  venereal  desires. 

45 


354  ON  THE  DISEASES 

13.  Several  medicines  have  been  recommended 
to  subdue  the  excess  of  the  sexual  appetite ; 
among  these,  the  caster  oil  nut,  and  camphor, 
have  been  most  commended.  The  former  acts 
only  by  opening  the  bowels,  and  thereby  taking 
off  the  tension  of  the  contiguous  genital  organs. 
Any  other  lenient  purge  would  probably  have  the 
same  effect.  If  camphor  have  any  virtues,  in  this 
disease,  it  must  be  by  its  stimulating  powers  re- 
moving that  nervous  debility  upon  which  vene- 
real excitability  depends.  Any  other  stimulating 
medicine  given  in  a  similar  state  of  the  system, 
would  probably  have  the  same,  or  a  greater  effect. 

1  have  thus  mentioned  all  the  remedies  for  de- 
rangement in  the  passions  and  sexual  appetite. 
While  I  admit  the  necessity  of  their  being  aided 
by  religious  influence,  in  order  to  render  them 
successful,  I  maintain  that  religious  influence  is 
seldom  effectual  for  that  purpose,  unless  it  be 
combined  with  those  physical  remedies.  This 
opinion  is  amply  supported  by  numerous  precepts 
in  the  Old  and  New  Testament,  and  it  is  only  by 
inculcating  those  physical  precepts,  with  such  as 
are  of  a  religious  and  moral  nature,  that  the  lat- 
ter can  produce  their  full  effects  upon  the  body 
and  mind. 


OP  THE  MIND.  355 


CHAPTER  XIX. 

Of  Derangement  in  the  Moral  Faculties. 

I  TOOK  notice  formerly  of  moral  derangement 
in  the  will,  and  mentioned  its  symptoms,  as  they 
appear  in  several  specific  vices.  This  disease 
discovers  itself  only  in  the  moral  faculty,  and  ex- 
ists with  a  sound  state  of  the  conscience  and 
sense  of  deity.  Under  the  present  head,  I  shall 
make  a  few  remarks  upon  moral  derangement,  as 
it  appears  in  all  those  moral  faculties  of  the  mind. 

For  an  account  of  the  nature  and  offices  of  the 
moral  faculty  and  conscience,  and  of  the  differ- 
ence between  them,  the  reader  is  referred  to  an 
oration  delivered  by  the  author  before  the  Ameri- 
can Philosophical  Society,  in  the  year  1786,  and 
published  in  the  first  volume  of  his  Medical  Inqui- 
ries and  Observations.  For  proofs  of  the  ex- 
istence of  an  innate  sense  of  deity  in  the  human 
mind,  the  reader  is  referred  to  Lord  Kaims* 
Sketches  of  the  History  of  Man.  All  these  facul-. 


356  ON  THE  DISEASES 

ties  are  liable  to  derangement,  partially  and  uni- 
versally. 

I.  Partial  derangement  in  them  is  sometimes 
induced, 

1.  By  ardent  spirits. 

2.  By  famine,  the  effects  of  which,  in  annihilat- 
ing the  obligations,  not  only  of  morality,  but  of 
consanguinity,  and  inducing  the  grossest  acts  of 
cruelty,  are  recorded  in  the  56th  and  57th  verses 
of  the  28th  chapter  of  Deuteronomy.     The  con- 
sonance  of  the  prediction   contained    in  those 
verses  with  the  state  of  the  human  mind,  in  simi- 
lar circumstances  of  distress  from  hunger,   has 
been  established  in  many  instances,  in  the  histo- 
ries of  crews  who  have  sought  relief  from  ship- 
wreck in  a  boat,  or  on  a  desolate  shore. 

II.  The  moral  faculty,  conscience,  and  the  sense 
of  deity,  are  sometimes  totally  deranged.  The 
Duke  of  Sully  has  given  us  a  striking  instance  of 
this  universal  moral  derangement,  in  the  character 
of  a  young  man  who  belonged  to  his  suit,  of  the 
name  of  Servin,  who,  after  a  life  uncommonly  dis- 
tinguished by  every  possible  vice,  died,  cursing 
and  denying  his  God.  Mr.  Halsam  has  described 


OF    THE    MIND.  357 

two  cases  of  it  in  the  Bethlehem  Hospital,  one  of 
whom,  a  boy  of  thirteen  years  of  age,  was  perfect- 
ly sensible  of  his  depravity,  and  often  asked  "  why 
God  had  not  made  him  like  other  men."  He  was, 
as  might  be  expected,  completely  miserable,  and 
often  expressed  a  wish  for  death.  An  epitome  of 
all  that  has  been  recorded,  or  perhaps  seen,  of 
this  derangement  in  the  moral  faculties,  has  been 
given  by  Edgar  of  himself,  in  the  tragedy  of  King 
Lear,  in  the  following  lines. 

4*  I  was  a  serving  man,  proud  in  heart  and  mind, 

That  served  the  lust  of  my  mistress'  heart, 

And  did  the  act  of  darkness  with  her ; 

Swore  as  many  oaths  as  I  spake  words ; 

Wine  I  loved  deeply,  dice  dearly : 

I  was  false  of  heart,  light  of  ear,  and  bloody  of  hand  ; 

Hog  in  filth,  fox  in  stealth,  wolf  in  greediness, 

Dog  in  madness,  and  lion  in  prey." 

In  the  course  of  my  life,  I  have  been  consulted 
in  three  cases  of  the  total  perversion  of  the  moral 
faculties.  One  of  them  was  in  a  young  man,  the 
second  in  a  young  woman,  both  of  Virginia,  and 
the  third  was  in  the  daughter  of  a  citizen  of  Phi- 
ladelphia. The  last  was  addicted  to  every  kind 
of  mischief.  Her  wickedness  had  no  intervals 
while  she  was  awake,  except  when  she  was  kept 
busy  in  some  steady  and  difficult  employment. 


3.08  ON  THE  DISEASES 

In  all  these  cases  of  innate,  preternatural  moral 
depravity,  there  is  probably  an  original  defective 
organization  in  those  parts  of  the  body,  which  are 
occupied  by  the  moral  faculties  of  the  mind. 

How  far  the  persons  whose  diseases  have  been 
mentioned,  should  be  considered  as  responsible 
to  human  or  divine  laws  for  their  actions,  and 
where  the  line  should  be  drawn  that  divides  free 
agency  from  necessity,  and  vice  from  disease,  I 
am  unable  to  determine.  In  whatever  manner 
this  question  may  be  settled,  it  will  readily  be  ad- 
mitted that  such  persons  are,  in  a  pre-eminent 
degree,  objects  of  compassion,  and  that  it  is  the 
business  of  medicine  to  aid  both  religion  and  law, 
in  preventing  and  curing  their  moral  alienation  of 
mind.  We  are  encouraged  to  undertake  this 
enterprise  of  humanity,  by  the  sameness  of  the 
laws  which  govern  the  body  and  the  moral  facul- 
ties of  man.  I  shall  venture  to  point  out  the  same- 
ness of  those  laws  in  a  few  instances,  by  mention- 
ing the  predisposition  and  proximate  causes,  the 
symptoms,  and  the  remedies  of  corporeal  and 
moral  diseases. 

I.  Is  debility  the  predisposing  cause  of  dis- 
ease in  the  body  ?  so  it  is  of  vice  in  the  mind. 


OF  THE  MIND.  359 

This  debility  in  the  mind  consists  in  indolence,  or 
a  want  of  occupation.  Bunyan  has  justly  said,  in 
support  of  this  remark,  that  "an  idle  man's  brain 
is  the  devil's  work-shop."  The  young  woman, 
whose  moral  derangement  I  mentioned  a  little 
while  ago,  was  always  inoffensive  when  she  was 
busy.  The  employment  contrived  for  her  by  her 
parents  was,  to  mix  two  or  three  papers  of  pins  of 
different  sizes  together,  and  afterwards,  to  oblige 
her  to  separate,  and  sort  them.  The  near  rela- 
tion of  debility  and  vice  has  been  expressed  by 
the  schoolmen  in  the  following  words,  "  non 
posse,  est  malum  posse."  To  do  nothing,  is  gen- 
erally to  do  evil. 

2.  Do  we  prevent  disease,  by  removing  the 
body  out  of  the  way  of  exciting  causes  acting  upon 
debility?     In  like  manner,  we  prevent  vice,  by  re- 
moving the  mind,  in  its  debilitated  state,  out  of 
the  way  of  bad  company,  and  thus  abstract  it 
from  the  stimulus  of  vicious  motives  upon  the  will. 

3.  Does  bodily  disease  consist  in  morbid  ex- 
citement, or  irregular  action?    Vice  consists,  in 
like  manner,  in  undue  excitement  of  the  passions 
and  will,  and  in  their  irregular,  or,  to  use  a  scrip- 
tural epithet,  in  their  "  crooked"  actions. 


360  ON  THE  DISEASES 

4.  Is  bodily  disease  a  unit?  So  is  vice.    All  its 
innumerable  forms  are  derived  simply  from  inor- 
dinate self-love. 

5.  Do  high  degrees  of  morbid  bodily  excite- 
ment require  depleting  remedies  ?  High  degrees  of 
vice  require  remedies  of  a  similar  nature,  such 
as  the  abstraction  of  company,  and  the  exces- 
sive or  criminal  gratification  of  the  passions  and 
senses. 

6.  Do  we  overcome  morbid  action  in  a  bodily 
disease  in  a  highly  vital  part,  by  exciting  it  in  a 
part  less  essential  to  life?    In  like  mariner   we 
cure  the  odious  vice  of  avarice,  and  a  debasing 
love  of  pleasure,  by  the  less  odious  and  debasing 
vice  of  ambition. 

7.  Is  it  impossible  to  produce  two  sensations 
of  unequal  force,  at  the  same  time,  in  the  body? 
It  is  equally  impossible  for  the  mind  to  act  under 
the  impression  of  two  motives  at  the  same  time. 
Hence  the  truth  of  that  declaration  of  our  Sa- 
viour, "  that  no  man  can  serve  two  masters,  that 
is,  God  and  Mammon."     The  predominance  of 
the  motive  excited  by  one  of  them,  will  always 
destroy  the  other. 


OP  THE  MIND.  361 

8.  Do  we  accommodate  stimuli  to  the  state  of 
excitability  in  diseases  of  the  body?    The  same 
thing  is  done  in  all  the  successful  applications  of 
moral  stimuli,  or  motives,  to  the  will.     Our  Sa- 
viour hints  at  this  accommodation  of  moral  reme- 
dies to  the  peculiar  state  of  the  mind,  when  he 
alludes  to  the  practice  of  not  putting  new  wine, 
full  of  an  active  fermenting   principle,  into   old 
bottles,  which  in  ancient  Judea,  were  made  of 
leather,  and  of  course,  became  weak  from  age. 

9.  Is  the  excessive  morbid  excitement  of  a  dis- 
ease worn  down  by  labour?    Excessive  vicious 
excitement  is  reduced  in  like  mariner  by  the  same 
means,  and,  in  addition  to  it,  by  solitude,  shame, 
and  certain  restraints  or  pains  inflicted  upon  the 
body,  of  a  nature  calculated   to   act  indirectly 
upon  the  mind.     I  acknowledge  the  first  impres- 
sions of  confinement  and  bodily  pain  generally 
produce  a  vicious  fretfulness,  and  sometimes  im- 
pious  expressions    and   immoral   conduct;     but 
these  effects  of  those  moral  remedies  are  general- 
ly very  transient.     When  continued  long  enough, 
they   never  fail  of  producing   a   change   in   the 
moral  temper   of  the  mind.     A  remarkable  in- 
stance of  the  truth  of  this  remark  occurred  some 
years  ago  in  the  jail  of  Philadelphia.     A  noto- 
rious   offender  amused  himself,   for   some   time 

46 


362  ON  THE  DISEASES 

after  his  confinement,  by  drawing  pictures,  and 
writing  verses  of  a  ludicrous  nature,  upon  the 
walls  of  his  solitary  cell.  At  the  end  of  several 
weeks  he  became  silent  and  pensive,  and  at  the 
same  time  the  following  passage  of  scripture, 
written  by  him,  was  discovered  upon  one  of  the 
walls  of  his  cells.  "  Come  unto  me,  all  ye  who 
labour  and  are  heavy  laden,  and  I  will  give  you 
rest." 

10.  Are  bodily  sensibility  and  irritability  weak- 
ened, or  destroyed,  by  the  protracted  application 
of  morbid  stimuli  to  sensible  and  irritable  parts  ? 
The  same  thing  takes  place  from  the  long  appli- 
cation of  vicious  impressions  to  the  moral  facul- 
ties of  the  mind.  They  become,  in  such  cases, 
to  use  the  words  of  one  of  the  apostles, kt  dead," 
and  "  seared  with  a  red  hot  iron."  A  disease  re- 
sembling a  palsy  affects  them  all. 

I  might  go  on  further,  and  mention,  more  par- 
ticularly, the  analogy  between  bodily  and  moral 
diseases,  and  the  propriety  of  adapting  specific 
remedies  to  specific  vices ;  but  enough,  I  hope, 
has  been  said  to  show  the  truth  and  importance 
of  the  subject,  and  the  practicability  of  the  under- 
taking, by  persons  whose  professional  studies  and 
employments  are  more  nearly  related  to  it  than 


OF  THE  MIND.  363 

the  author's.  However  useful  the  rational  and 
physical  remedies  that  have  been  mentioned  may 
be  to  prevent  or  cure  vice,  they  never  can  per- 
form that  work  completely,  without  the  aid  of  that 
supernatural  and  mysterious  remedy  which  it 
hath  pleased  God  to  unite  with  them  in  his  moral 
government  of  his  creatures,  and  that  is,  the  FOR- 
GIVENESS of  it.  In  vain  have  legislators  substi- 
tuted the  exterminating  axe  and  halter,  and  the 
influence  of  ignominious  or  painful  corporeal  pun- 
ishments, for  this  divine  mode  of  curing  moral 
evil.  The  danger  and  mortality  of  the  venereal 
disease  were  increased,  in  former  times,  by  the 
contempt,  neglect,  and  corporeal  chastisement, 
to  which  persons  affected  with  it  were  exposed. 
Since  the  pain  and  shame  of  the  disease  have 
been  considered  as  its  ample  punishments,  and 
the  subjects  of  it  restored  to  public  favour,  the 
disease  has  every  where  declined,  and  is  now 
rarely  attended  with  danger,  or  the  loss  of  life. 
The  abolition  of  the  punishment  of  death,  and  of 
cropping,  branding,  and  public  whipping,  and  sub- 
stituting for  them,  confinement,  labour,  simple 
diet,  cleanliness,  and  affectionate  treatment,  as 
means  of  reformation  and  forgiveness,  have  pro- 
duced similar  moral  effects  in  the  jail  of  Philadel- 
phia. If  this  original  and  humane  institution,  in 
which  science  and  religion  have  blended  their  re- 


364  ON  THE  DISEASES 

sources  together,  has  not  been  attended  with 
uniform  success,  it  must  be  ascribed  wholly  to 
the  imperfect  mariner  with  which  the  principles 
that  suggested  it  have  been  carried  into  effect. 
They  have  been  rendered  abortive,  chiefly,  by  the 
criminals  sleeping  in  the  same  room,  and  by  the 
facility  and  frequency  with  which  pardons  are 
obtained  for  them.  The  former  prevents  the  re- 
suscitation of  conscience,  and  all  moral  and  re- 
ligious reflection.  The  latter  is  opposed  to  the 
great  axioms  upon  which  the  penal  law  of  Penn- 
sylvania is  founded ;  that  "  punishments  should  be 
certain,  but  not  severe,  and  that  a  pardoning 
power  should  not  be  lodged  in  any  department  of 
a  government." 

May  this  Christian  system  of  criminal  jurispru- 
dence be  spread,  without  any  of  its  imperfections, 
throughout  the  world !  and  may  the  rulers  of  na- 
tions learn  from  it,  that  the  reformation  of  crimi- 
nals, as  well  as  the  prevention  of  crimes,  should 
be  the  objects  of  all  punishments,  and  that  the 
latter  can  be  effected  much  better  by  living  than 
by  dead  examples ! 

Here  the  reader  and  the  author  must  take  leave 
of  each  other.  Before  I  retire  from  his  sight,  I 
shall  only  add,  if  I  have  not  advanced,  agreeably 


OF  THE  MIND.  365 

to  my  wishes,  the  interests  of  medicine  by  this 
work,  I  hope  my  labours  in  the  cause  of  humani- 
ty will  not  be  alike  unsuccessful;  and  that  the 
sufferings  of  our  fellow  creatures,  from  the  causes 
that  have  been  mentioned,  may  find  sympathy  in 
the  bosoms,  and  relief  from  the  kindness  of  every 
person  who  shall  think  it  worth  while  to  read  this 
history  of  them. 


THE  END. 


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families,  Sunday  schools,  or  companies  assembled  for  religious  instruction  in 
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These  sermons,  which  are  characterized  by  a  beautiful  simplicity,  the  en- 
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many  and  large  editions,  and  been  translated  into  several  of  the  continental 
languages.  "  They  have  also  been  the  honoured  means  hot  only  of  convert- 
ing many  individuals,  but  also  of  introducing  the  gospel  into  districts,  and 
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regular  Reading  of  the  Scriptures.  By  the  Rev.  S.  G.  Winchester,  A.  M. 

The  subject  is  one  of  incalculable  practical  importance,  and  is  treated  in  a 
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Essay  on  the  obligation,  nature,  and  importance  of  Family  Religion ;  and  we 
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Carpentry,  Joinery,  &c.  in  1  vol.  4to. 

The  Theory  and  Practice  well  explained,  and  fully  exemplified  on  eighty- 
four  copperplates,  includingsome  observations,  &c.,  on  the  strength  of  Tim- 
ber- by  Peter  Nicholson.  Tenth  edition.  This  invaluable  work  superseded, 


on  its  first  appearance,  all  existing  works  on  the  subject,  and  still  retains  it» 
original  celebrity. 

Every  Carpenter  in  our  country  should  possess  a  copy  of  this  invaluable 
work. 

HIND'S  POPULAR  SYSTEM  OF  FARRIERY,  taughton  an-w 
and  easy  plan,  being  a  Treatise  on  all  the  diseases  and  accidents  to  which 
the  Horse  is  liable.  With  considerable  additions  and  improvements,  adapted 
particularly  to  this  country,  by  Thomas  M.  Smith,  Veterinary  Surgeon, 
ana  member  of  the  London  Veterinary  Medical  Society,  in  1  vol.  12mo. 

The  publisher  has  received  numerous  flattering  notices  of  the  great  practi- 
cal value  of  this  work.  The  distinguished  editor  of  the  American  Farmer, 
speaking  of  the  work,  observes — "We  cannot  too  highly  recommend  this 
book,  and  therefore  advise  every  owner  of  a  horse  to  obtain  it." 

NEW  SONG  BOOK.— Grigg's  Southern  and  Western  Songster;  be- 
ing a  choice  collection  of  the  most  fashionable  songs,  many  of  which  are  ori- 
ginal, in  1  volume,  18mo. 

Great  care  was  taken  in  the  selection  to  admit  no  song  that  contained,  in 
the  slightest  degree,  any  indelicate  or  improper  allusions — and  with  great  pro- 
priety it  may  claim  the  title  of  "  The  Parlour  Song  Book  or  Songster."  The 
immortal  Shakspeare  observes, — 

"  The  man  that  hath  not  music  in  himself, 
Nor  is  not  moved  with  concord  of  sweet,  sounds, 
Is  fit  for  treasons,  stratagems,  and  spoils." 

SAY'S  POLITICAL  ECONOMY.  A  Treatise  on  Political  Econo- 
my, or  the  Production,  Distribution,  and  Consumption  of  Wealth.  By  Jean 
Baptiste  Say.  Fifth  American  edition  with  Additional  Notes,  by  C.  C. 
Biddle,  Esq.,  in  1  vol.  8vo. 

The  editor  of  thr>  North  American  Review,  speaking  of  Say,  observes, 
that  "he  is  the  most  popular,  and  perhaps  the  most  able  writer  on  Political 
Economy,  since  the  time  of  Smith." 

The  distinguished  biographer  of  the  author  in  noticing  this  work  observes, 
"  Happily  for  science  he  commenced  that  study  which  forms  the  basis  of  his 
admirable  treatise  on  Political  Economy,  a  work  which  not  only  improved 
under  his  hand  with  every  successive  edition,  but  has  been  translated  into 
most  of  the  European  languages." 

This  work  has  been  introduced  as  a  text  book  into  the  principal  Univer- 
sities and  Colleges  of  our  country,  as  well  as  in  Europe. 

It  would  be  beneficial  to  our  country  if  all  those  who  are  aspiring  to  office, 
were  required  by  their  constituents  to  be  conversant  with  the  pages  of  Say. 

RUSH  ON  THE  HUMAN  VOTCE.  Embracing  its  Physiological 
History,  together  with  a  System  of  Principles,  by  which  criticism  in  the  art 
of  Elocution  may  be  rendered  intelligible  and  instruction  definite  and  com- 
prehensive. To  which  is  added,  a  brief  Analysis  of  Song  and  Recitative; 
second  edition,  with  additions.  By  James  Rush,  M.  D. 

A  DICTIONARY  OF  SELECT  AND  POPULAR  QUOTA- 
TIONS, which  are  in  daily  use;  taken  from  the  Latin,  French,  Greek, 
Spanish,  and  Italian  languages ;  together  with  a  copious  collection  of  Law 
maxims  and  Law  terms;  translated  into  English,  with  illustrations,  historical 
and  idiomatic.  Sixth  American  edition,  corrected  with  additions.  1  vol. 
12mo. 

In  preparing  this  Sixth  edition  for  the  press,  care  has  been  taken  to  give 
the  work  a  thorough  revision,  to  correct  some  errors  which  had  before  escaped 
notice,  and  to  insert  many  additional  Quotations,  Law  maxims  and  Law 
terms.  In  this  state  it  is  offered  to  the  public  in  the  stereotype  form.  This 
little  work  should  find  its  way  into  every  Family  Library. 

SENECA'S  iMORALS.— By  way  of  abstract  to  which,  is  added,  a  Dis- 
course under  the  title  of  an  After-Thought,  by  Sir  Roger  L'Estrange,  Knt. 
A  new  fine  edition,  in  vol.  18mo. 

A  copy  of  this  valuable  little  work  should  be  found  in  every  family  library. 


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